The most corrupt and dangerous entities in the history of humankind is the American medical industry aka the Medical Mafia and the White Coat Mafia. Here is what they do.
- Billing for services, treatment or assessments that are not provided, not medically necessary or that lack documentation
- Committing medical identity theft
- Altering and/or falsifying documentation
- Double-billing, balance billing, upcoding or other inappropriate billing
- Unbundling services
- Billing for unreasonable or inflated hours
- Falsifying credentials
- Substituting generic drugs
- Billing for more expensive procedures than were performed or unallowable expenditures
- Soliciting or accepting kickbacks
- Submitting false cost reports
- Billing from a non-credentialed site or for services that the provider or staff are improperly or not licensed to perform
Waste is defined as the misuse, underutilization or overutilization of items or services. This could also be any other inappropriate or unnecessary billing, as well as medical practices that directly or indirectly add to healthcare costs. This also includes unwarranted or unexplained variations in care that result in no discernible differences in health or member outcomes.
Abuse is defined as provider practices that are inconsistent with sound fiscal, business or medical practices and result in an unnecessary cost to the Medicaid program, reimbursement for services that are not medically necessary or those that fail to meet professionally recognized standards for healthcare. It also includes beneficiary practices that result in unnecessary costs to the Medicaid program. Examples include:
- Overutilization of medical and healthcare services
- Separate billing for care and services that are part of an all-inclusive procedure or included in the per diem rate
- Billing for care and services that are provided by an unauthorized or unlicensed person
- Failure to provide and maintain proper quality of care, appropriate care and services or medically necessary care and services within accepted medical standards for the community
- Breach of the terms and conditions of contracts
- Failure to comply with requirements of certification
- Failure to comply with the provisions for submitting claims for payment
- Failure to comply with controlling authority
All of the above amounts to theft. Doctors and hospitals are thieves. No other industry is more corrupt or more dangerous than the American health care industry AKA the American Medical Mafia. Medical crime is the biggest crime in the world.
