Pharmaceutical and medical implement companies (implants, testing and treatment devices, etc.) are generally honest and ethical. They are also held accountable by government regulators, but the potentially enormous sums of money involved can cause a rush to market, where the company may shortcut research and testing in hopes of recouping development expenses. Read More
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Subtle Fraud
January 19, 2014
In The Pain Doc the fraud is more subtle. The patients are often legitimate folks with legitimate problems sometimes severe. These patients are over-treated and their insurance over-charged for services not needed, not properly done and sometimes not done at all. The patients are kept in the circle of profit by addicting them to opiates and continuing to offer false hope. Sometimes the patient is complicit to get drugs or money such as in Mr. Wrubel’s “choreographed auto crashes”. Here again, the victims are the non-complicit patients and the insurance companies, sometimes Medicare but often workman’s compensation and auto insurance which in some states can have ultra-deep pockets for the physician skilled in billing them. Read More
Overt Fraud
January 12, 2014
In THE CORRIDOR the fraud is overt—billing for services not done, often to patients not present or even non-existing, or bribing people to provide their insurance information to bill for non-existent services. The victims are both the payers—usually Medicare and Medicaid as well as the poor people sucked into the scheme. However, there are much more sophisticated and subtle forms of healthcare fraud as seen in THE PAIN DOC. Read More
The Labyrinth
January 7, 2014
THE LABYRINTH, the third book in a series of fast moving thrillers set in the underworld of healthcare fraud is soon to be released. This will be announced here and on Amazon as well as my facebook page Wilmont Kreis, author. The dictionary defines fraud as trickery or deception, also crime of cheating somebody, but is this really what healthcare fraud is? I think it has a much larger scope and will talk about it for the next few blogs. Read More