Monday, January 17, 2011


Medicaid’s corporate crime machine

by Larry Geller

An article posted yesterday on the Disability Mom blog dissects corporate Medicaid programs. What’s reveled is a very ugly picture. Nor is Hawaii excluded.

The article starts at the top…

The link between well-publicized Medicaid cuts, state budget deficits, criminal Medicaid fraud and the corporate penetration of Medicaid (and Medicare) has gone largely unnoticed. There are further correlations between corporate expansion into Medicaid, and November’s congressional races where Republicans ousted sitting Democrats with the help of more than $54 million in “outside” contributions

…. and goes through the system to the seedy bottom:

Sean Hellein’s False Claims Act complaint was filed against eight companies, including Wellcare, UnitedHealth, Amerigroup and Humana. It details how the companies “cooperate with each other by consciously making the same false claims” to state Medicaid offices.  Hellein told a reporter that “each uses a different technique for hiding the overcharges to make it harder for the state to catch on”.

Hellein’s complaint was also filed in Illinois, Indiana, Louisiana, New York, Georgia and Hawaii, where, according to Hellein, similar criminal Medicaid fraud schemes are being perpetrated by the named companies.  When Wellcare floated the idea of the $137 million settlement, Hellein said the actual damages were closer to $400-600 million.

[Disability Mom, The Medicaid Money Machine: Is it creating a corporate criminal culture, 1/16/2011]

It’s a fine article, please click the link and read it if you are concerned with our healthcare system nationally or in Hawaii.


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Thank you, Larry.

And because the for profit health insurance Industry has millions to spend to protect their profits they have crafted a brilliant messaging campaign which rings true to low information conservative voters. "Medicaid is going broke because of paitient fraud, the health insurance companies are doing their best to curb this fraud by Medicaid participants but are overwhelmed by the scope of the problem". Privatization of government services is turning out to be the biggest fraud since the Iraq War.

According to Wellcare's first quarter 2011 SEC filing, Hawaii is one of nine states that just signed (April 26, 2011) an agreement between Wellcare, and all the federal agencies currently investigating the company for Medicaid fraud. While the agreement apparently gives Wellcare a get out of jail free card, it still seems to me to mean we're doing business with crooks. In fact, we're putting the lives and wellfare of our children and people with disabilities into the hands of people who are agreeing to a settlement without admitting guilt to criminal Medicaid fraud, including schemes that targeted funds for children.

Settling without admitting guilt is probably the rule rather than the exception. Corporations may be "persons" to the Supreme Court, but they somehow don't end up doing jail time.

Same for doing business with crooks. Keep in mind that under the settlement they are not crooks.

There is a mutual benefit arrangement between government and corporations. We ordinary people only get it their way if we get upset with it enough to take action. Too often, we just get swatted like mosquitoes even if we do take action.

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