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Fraudulent claims paid by Medicare and Medicaid for supposed patient transportation needs

Fraudulent claims paid by Medicare and Medicaid for supposed patient transportation needs

By Megan Porter, Marketing

Billions of dollars are spent on health each year in the United States. In fact, if not for health insurance, many residents would not be able to afford the cost of medical treatment, from ambulance rides to hospital bills to surgical procedures. To help those who can’t afford medical care or insurance on their own, the United States government established the Medicare and Medicaid programs, which offer to cover certain services for those who qualify.

However, there are many health care providers who seek to take advantage of government funding by billing Medicare and Medicaid incorrectly. Such was the case with Clifford Shoemake and Kimberly Conner, owners of the Guam Medical Transport company (GMT). According to Medicare guidelines, Medicare will pay for patients to have scheduled ambulance rides for medically necessary treatment (like dialysis, for example) if the patient is unable to obtain alternative transport means or if the patient’s condition precludes traditional transport methods. Shoemake and Conner, though, were billing Medicare for medically unnecessary transport for patients who could have used traditional transport methods. Shoemake and Conner also encouraged other employees in their company to remove any evidence from medical notes that showed patients could function on their own, which would have caused Medicare to deny coverage for the transport claim.

Shoemake and Conner admitted to submitting fraudulent claims over the space of four years, from 2010 to 2014. During this time, they received nearly $11 million for those claims. The owners of GMT also admitted to using these fraudulently gained funds for personal benefit, including the purchase of a home and vacation expenses. After a long trial, both were sentenced to spend between five and six years in prison. They were also required to forfeit and repay the U.S. government an amount equivalent to the fraudulently received funds.

EyeDetect®, an innovative lie detection solution that uses a computer and eye tracker to monitor involuntary responses in the eyes when one lies called could have been used in this situation to catch the fraud earlier by testing health care workers for violation of the Fraud, Waste, and Abuse Act. EyeDetect could also have been used profitably in the court case to determine far more quickly the truth of the situation and avoid costly prosecution fees. This would save the government both time and money that would be better spent improving the lives of impoverished citizens.

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Photo by / F. Muhammad