Health care fraud

My favorite class of the quarter (so far) is my fraud examination class. As an auditor, I'll certainly be looking for cases of fraud, but it's not really going to be the main concern of my job. And if I DO find an instance of fraud, it's usually turned over to E&Y's fraud department, so I wouldn't even get to work on the investigation probably. So basically this class talks about everything that I WANT to do in my job, but won't ever get to haha.

Anyway, today we had a speaker from the Ohio Bureau of Worker's Compensation. He's in their anti-fraud department, meaning he investigates claims of fraud. Examples: a doctor that bills for expensive procedures they didn't perform (because the BWC pays the bills), or an employee who files a worker's comp claim saying they were hurt on the job, but they're just abusing the system and are actually completely fine. So essentially they handle various cases of people screwing the state out of money.

He gave some examples of cases he's worked on, and they are just so unbelievably interesting. It makes me sad that my job is going to be so NOT interesting compared to this.

Here's a case of his that was highlighted on the TV show "American Greed" on CNBC, if any of you have seen it. This is a completely egregious case, so not all of the cases are like this, but it's an example of the kind of work they do. They'll work with other departments in Ohio like the state attorney, the Department of Taxation, etc. They'll also work alert Medicare and Medicaid if they think they're getting screwed, too (and oftentimes they are).

Anyway, here's the link to the American Greed website on the case: http://www.cnbc.com/id/19488935

The doctor's from Cleveland and long story short: He was basically acting as a legal drug dealer. He also gave people unnecessary shots and billed them as shots that were much more expensive than the ones he was giving (therefore pocketing tons of money).

I feel like this just has me like, riled up now about the issue of health care fraud. Soooo many people are scamming the system, causing us as taxpayers and as beneficiaries of insurance to pay SO MUCH MONEY. Like, the state pays out this money. I don't know for sure, but I would assume that this is taxpayer money. Doctors are screwing the state by "upcoding" (saying they performed more services than they actually did, thus getting more money as a reimbursement), employees are screwing the state by making worker's comp claims that they're permanently and totally disabled... if you make that claim, you're legally NOT ALLOWED to work. But they track down people every day who are doing just that. So they're receiving disability checks AND they're working, so they're essentially getting two paychecks out of this, which is completely illegal. UGHHHH it drives me crazy.

And it doesn't help that this makes me feel like my job is totally inadequate. I'll just be reviewing financial statements for the rest of my life. The people that work in this department are helping the state get money back that's rightfully theirs. It just seems so much more... noble haha. And they get to do sweet stuff like go undercover to doctor's offices, they get to testify in court... basically my dream of living out Law and Order: SVU. One day. One day.