Pluralistic: America's richest Medicare fraudsters are untouchable (13 Nov 2024)


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A man in a top hat smothering a girl in a bed with a pillow. The girl's protruding arm is blue. He is being handed a sack of money by Uncle Sam in a Santa suit. At their feet is a fizzing bomb with an oxygen tank label.

America's richest Medicare fraudsters are untouchable (permalink)

"When you're famous, they let you do it": eight words that encapsulate the terrifying rot at the heart of our lived experience, a world where impunity for the powerful trumps the pain of their victims.

"Populism," is shorthand for many things: rage, despair, distrust of institutions and a desire to destroy them. True populism seeks to channel those totally legitimate feelings into transformative change for a caring and fair society for all. So-called "right populism" exploits those feelings, using them to drive a wedge between different groups of victims, turning them against each other, so that elites can go on screwing the squabbling factions.

The far-right parties that are marching to victory through a series global elections are different in many ways, but they all share one trait: they appeal to mistrust of institutions, claiming that the government has been captured by elites who serve them at the expense of the governed. This has the benefit of being actually true, and while the fact that far-right parties are owned by these government-capturing elites might erode their credibility, the fact that so many "progressive" parties have stepped in to defend the institutional status quo leaves an open field for reactionary wreckers:

https://www.politico.com/blogs/2016-dem-primary-live-updates-and-results/2016/02/hillary-clinton-donald-trump-slogan-219908

Why would voters turn out to support a "Department of Government Efficiency," run by a bully whose career has been defined by abusing the people he is in charge of? Maybe they're turkeys voting for Christmas, but they also have personal, traumatic experience with government departments that protected the abusive corporations that preyed on them.

Today on Propublica, Peter Elkind tells the incredible story of Lincare, the nation's leading supplier of home oxygen, a repeat-offender fraudster and predator that has made billions in public money without any real consequences:

https://www.propublica.org/article/lincare-medicare-lawsuit-settlements-oxygen-equipment

Lincare has been repeatedly found guilty of defrauding Medicare; in this century alone, they have been put on probation four times, with a "death penalty" provision that would permanently disqualify them from ever doing business with the federal government. In every case, Lincare committed fresh acts of fraud, but never faced that death penalty.

Why not? Lincare is far too big to fail. In America's bizarre, worst-in-class, world-beatingly expensive privatized health care system, even public health provision (like Medicare) is outsourced to the private sector. Lincare has monopolized oxygen, a famously very important molecule for human survival, and if it were disqualified from serving Medicare, large numbers of Americans would literally asphyxiate.

Lincare clearly knows this. Too big to fail is too big to jail, and too big to jail is too big to care. They are the poster children for impunity, repeat offenders, multiply convicted, and still offending, even today. Lincare has been convicted of fraud under the administrations of GW Bush, Obama, Trump and Biden, and they're still in business.

What a business it is! Elkind takes us to the asbestos-poisoned town of Libby, Montana, where more than 2,000 of the 2.857 population suffer from respiratory diseases from the open-pit mine that operated there from 1963-1990. The elderly, dying population of this town rely on Medicare and Medicare Advantage oxygen concentrators to draw breath, and that means they rely on Lincare.

That means they are prey to Lincare's signature scam: charging Medicare (and 20% co-paying patients) to rent an oxygen concentrator every month, until they have paid for it several times over. This is illegal: under federal rules, patients are deemed to have bought their oxygen concentrators after 36 months and contractors are no longer allowed to charge them. Lincare doesn't give a fuck: the bills keep coming, and Lincare patients who survive long enough have paid the company $16,000 for a $799 gadget.

When Brandon Haugen, a local Lincare customer service rep, noticed this and queried the company's home office in Clearwater, Florida (home to Scientology and the Flexidisc), he was given the brushoff. After multiple attempts to get company leadership to acknowledge that this was illegal, he quit his job, along with his colleague and childhood friend Ben Montgomery. Between them, Haugen and Montgomery had 14 children who depended on their Lincare paychecks. Despite this, they both quit and turned whistleblower, with no job lined up. Eventually, Lincare paid $29m to settle the claim, with $5.7m to the whistleblowers and their lawyers. For Lincare, this was part of the cost of doing business and the fraud rolls on.

Lincare doesn't just defraud Medicare, they also have a high-pressure commissioned sales force that has repeatedly been caught defrauding Lincare customers – overwhelming sick, poor, elderly people. Patients are pressured to accept auto-billing, then Lincare piles medically dubious gadgets onto their monthly bills, as well as useless, overpriced "patient monitoring" services. Customers with apnea machines are mis-sold ventilators by salesmen who falsely claim these are medically necessary.

Salespeople illegally auto-shipped parts and consumables for Lincare machines to patients, then billed them for it. To satisfy the legal requirement that they telephone patients before placing these orders, sales agents would call patients, put them on hold, then part the call until the patient hung up.

Salespeople are motivated by equal parts greed and terror. Make quota and you can get up to $8,000 per month in bonuses. Miss that punishing quota and you're out on your ass (which is why one salesperson ordered a medically unnecessary ventilator).

Lincare also habitually ignores requests to pick up medically unnecessary equipment, because so long as the equipment is on the patient's premises, they can continue to bill for it. As one Ohio manager wrote to their staff: "As we have already discussed, absolutely no pick-ups/inactivation’s are to be do[ne] until I give you the green light. Even if they are deceased." Execs send out company-wide emails celebrating regional managers who have abandoned pick-ups, like a Feb 2022 "Achievement Rankings" email that touted the fact that most regional centers had at least 150 overdue pickups.

Lincare represents a deep, structural rot in American society. They are too big to punish, and too powerful to regulate. A 2006 law meant to curb oxygen payments was gutted by industry lobbyists. Today, Congress is weighing legislation, the SOAR (Supplemental Oxygen Access Reform) Act, which will allow Lincare to bill the public for hundreds of millions more every year, raising rates and eliminating competitive billing. The bill is supported by patient advocates who are rightly interested in getting oxygen to patients who have been locked out of the system, but the cost of that inclusion is that Lincare will be even more firmly insulated from its corruption.

The Trump Administration will doubtless crack down on some of America's worst companies, and the furious voters who elected the only candidate who campaigned on the idea that America was rotten will cheer him on. But Trump has made it clear that he will select the targets of his administration based on whether they are loyal to him or stand in his way, without regard to whether they harm his supporters:

https://pluralistic.net/2024/11/12/the-enemy-of-your-enemy/#is-your-enemy

Companies like Lincare, repeatedly caught paying illegal kickbacks, know how to play this game.

(Image: p.Gordon, CC BY 2.0, modified)

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#1yrago The (open) web is good, actually https://pluralistic.net/2023/11/13/this-is-for-everyone/#revisiting

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