Fraud

[NC29mom, ASN, LPN, RN]

I wish I could open a business in which I investigated, and reported citizens for fraud. Medicare/Medicaid/SSI/Disability/ Food Stamps.....you name it.

As a society, we have become dependant upon our government for everything (not everyone, of course). There are young people fully capable of working a job (might not be the job they want, or pay they need, but its the job they qualify for) who live off us taxpayers. While our elderly (who couldn't work if they wanted to), live off pennies a month. Its utterly embarrassing and disgusting.

Im speaking from my personal experiences. Not trying to step on any toes, or start an argument. ...just wondering if such a business could exist? The government doesn't seem interested in doing anything but GIVING our hard earned dollars AWAY.

Does anybody know if this could be a legit business? Investigating and reporting government fraud?

[Faralas]

If it doesn't exist, you need to start it!! That's a great idea and I couldn't agree more.

[Bubbles]

If you were working as a Nurse Consultant dealing with persons injured in auto or industrial accidents you would sometimes find people who have not been truthful with thier attorney. Or you might find someone was injured, but tried to blame it on some other accident with insurance. You would also find there are a lot of people who have been seriously injured and are being treated fairly. It is a mixed bag with some getting by when they could be working and others getting screwed (like nurses and nursing assistants with injuries). Also beware of the so called physicians who do IMEs. I have seen that some are not really 'independent' and will provide a report with what they think the insurance company wants to hear. There is a related sort of work involving private investigators who are the ones filming the so called injured worker off on disability pushing a stalled car up a hill or doing their own roof! Pretty interesting stuff out there! Some people are in fact dishonest and some are honestly injured.

[LoriRNCM, ADN, ASN, RN]

My aunt is an RN and during the later part of her career she worked for medicare investigating nursing home fraud.

[imintrouble, BSN, RN]

Fraud has become as much a part of our society as social programs that promote it. We have entire divisions of our government that are supposed to watch dog fraud, and they can't control it.

I like your idea. I'm just not sure anybody would hire you.

[eyesopen_mouthshut, CNA]

Not sure if it's a business or not... I know a pharmacist who, on his off time, works with DEA and county officials to stop pill mills and give expert testimony in court... Maybe something like that would prove beneficial to what you're looking in to? You remain a nurse, maybe even get higher levels of education (MSN, DNP, etc) so that you could use your knowledge to be a legitimate resource for investigators. I think that sounds really awesome.

[gonzo1, ASN, RN]

Insurance companies hire RNs to investigate claims. They usually want 2-3 years experience in either ICU or ER. It is definately something to work toward. I have a neighbor who does this.

I may sometime in the future, but right now I still love bedside ICU and ER nursing.

[NC29mom, ASN, LPN, RN]

My aunt is an RN and during the later part of her career she worked for medicare investigating nursing home fraud.

So did she work for a particular office in Medicare? Can you elaborate?

Thanks for all the feedback. I was hoping I could be self employed, investigate, and report those who do commit fraud. The government could pay me in some way.....and it would be a 'win win' situation.

My mother actually works in Medicaid. She says they go above and beyond to NOT take benefits away or prosecute for fraud. In her 20+ years, she could only remember one instance where a client was charged, tried, and convicted. "The Government just turns a blind eye to fraud....as if theres too much effort involved" . So, I can make it easy for them......be glad to!

I know they have a "whistleblower" program...but its for providers committing fraud. Uncle Sam is more interested in chasing providers than patients.

And, yes there are definitely ones who deserve help & likely more than what they actually get. Sadly, I have learned, the ones who really need the help..........dont get it.

[captain_serenity]

Do it!!

[Munch]

I guess this would be considered fraud. One of my friends down in the ER talks about it happening all of the time. People without insurance coming into the ER saying they were injured in a car accident. Obviously with car accident the car insurance company picks up the tab via no fault....it's the law. These patients are waived any payment at the time of treatment. So off they go thinking they got one over on us..little do they know is that they get the bill IN FULL if the no fault info isn't filled out. That's for the stupid ones. The smarter ones leave us with phony addresses so they never get any bills at all. I mean that has to be some kind of fraud isn't it? Saying you were in a car crash to get treatment without having to use health insurance?

[HealthyNurse]

I work for the government as a health care surveyor. Unfortunately, CMS (Centers for Medicare and Medicaid Services) turns a blind eye to fraud. We do have avenues of reporting fraud to the OIG, but CMS actively encourages us not to get too involved. When we do report to the OIG, it takes a lot to get them interested (the fraud has to be a certain type and hit a certain threshold in the millions of dollars). I don't mean to discourage you, but that's the reality of it.

[Bubbles]

I work for the government as a health care surveyor. Unfortunately, CMS (Centers for Medicare and Medicaid Services) turns a blind eye to fraud. We do have avenues of reporting fraud to the OIG, but CMS actively encourages us not to get too involved. When we do report to the OIG, it takes a lot to get them interested (the fraud has to be a certain type and hit a certain threshold in the millions of dollars). I don't mean to discourage you, but that's the reality of it.

- Any idea why? Is it based on cost benefit analysis?