The owner of Apple of Your Eye Healthcare Services, Inc., Wilbert James Veasey, Jr. of Dallas, Texas, was sentenced in federal court on Tuesday, June 13, 2017, to 210 months in prison. Not insignificantly, he was also ordered to pay $23,123,897.18 in restitution to Medicare. I emphasize that figure so that it might soak in just how easy it is to become a millionaire at the expense of taxpayers. I must emphasize equally, however, that you shouldn’t fall for the tired arguments that social safety nets for the poor and vulnerable – Medicare and Medicaid primarily – are to fault.

The scheme by which Veasey and several others became enriched – you can read about it here – was more grossly outward and brazen than what I am used to seeing. Right out of an episode of American Greed, these folks were all in on going door-to-door in neighborhoods, and literally enticed the homeless with Big Macs to become ‘patients’ with phantom illnesses. It never ceases to amaze me just how engrossed these con-artists can be in their illegal conspiracy, oblivious to the the obvious bad ending that looms just around the corner in all these cases.

What is not so apparent but I contend is much more costly to Medicare, Medicaid, and you and me, is what takes place in the healthcare industry in general. Medical ‘specialists’ have taken over our healthcare and seek reimbursement for so very, very many tests that turn up nothing; zilch; nada. On the other hand – and perhaps the biggest culprit – is the hospitals who have found a way to ‘code’ billing so as to ensure higher reimbursements so that a 45-minute visit to the E.R. for sprained ankle turns into a $2200 bill, and a routine 2-day surgery will top $100,000. If Medicare is involved, they will settle quickly that $100,000 bill for $12,000. Why? Because that is really what it was worth and they know it.

I have represented the elderly and their families in nursing home abuse cases for over 20 years. Not once – and I am not exaggerating – not once have I reviewed a file that did not contain charting fraud. Most every resident is either Medicare and/or Medicaid, and these facilities routinely cheat. I’ve seen them bill for physical therapy on someone who is bedridden. I have reviewed files where they bathed dead people, i.e. they billed for bathing when in fact they were dead. There is no end to what I can list in the way they cheat. And, that means they are cheating me and you!

So, be vigilant to review billing and question the need for tests, especially when your deductible has not been met – if you are fortunate enough to have healthcare coverage.