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Spot The Sore Loser —United States v. Jamil, Et Al

Multinational pharmaceutical brands will "accidentally" cause some deaths and need only a few news cycles and perhaps compensatory damages to absolve them in the eyes of the laws and of the public. However, when mere mortals make full use of an objectively broken system and commit Medicare fraud, the same entities will label them morally reprehensible.

A dog dressed as a doctor

The only difference between the two is that individuals overlook the importance of allocating a portion of their funds for generous donations to decision-makers. I'm Andy Lazris, and I've read and written enough healthcare reform books to know that such is the way of medicine in America. Medicare fraud is practically a rite of passage for doctors who are less than honest because of the gaping holes in America's best efforts to care for the elderly and the ailing.

If you buy The Geriatric Vengeance Clubonline, you'll see that neglect doesn't even top the list of blatantly atrocious acts against those who need care the most. If you shop for a healthcare system-related book, you'll see that monetary incentivization to do the wrong thing is rampant in hospitals, pharmaceutical companies, and even health insurance programs. The workings of Medicare and Medicaid seem to be constructed to streamline the process of scamming patients when they are at their most vulnerable. Medicare fraud occurs daily, yet somehow policy seems to crack down every once in a while, citing great violations of the humanitarian and compassionate ways of practicing medicine, as if they are not already interwoven into our respected institutions.

The Jamil Case

T he actual atrocity that the industry can't stand is when people like the Jamils come along publicly profiteering off of the rules in place, flouting the need for discretion and thinking of themselves as entitled to the same leeway as the corporations that fund political campaigns. Mr. and Mrs. Jamil owned multiple health agencies in the Detroit metropolitan area and used them as a front to submit about $50 million worth of medical bills to Medicare. They also use straw owners to conceal their interest in the companies and avoid raising questions. They also recruited and bribed a team of co-conspirators to send patients their way for home healthcare, although in many cases, they didn't need or qualify for it, like villains out of a medical fiction book.

A doctor getting consult from friends

It might sound highly complicated, but when the couple worked with other physician clinics they were easily able to access information for highly lucrative Medicare fraud. Their case included 16 defendants, out of which twelve were doctors, and according to documents, crimes were perpetrated from 2007 to 2018. According to the DEA, the physicians involved were the highest prescribers in the state of Michigan for oxycodone and other highly addictive drugs.

The beneficiaries invested in self-promotion and expensive lifestyles, including private jet flights and high and real estate. So over 11 years, it went perhaps not unnoticed but was overlooked that patients were being billed for treatments they were not receiving or didn't need and that a group of doctors was living off of a side career as highly efficient drug dealers.

Now as punishments are being doled out, and public figures are falling over themselves to state repeatedly how unconscionable these acts were, nobody seems to notice how preposterous it is that they were allowed to occur in the first place. Pardon me for saying so, but it's not possible that lawmakers are under the impression that we live in a time where morality is given any real priority over profit. The healthcare system is supposed to be designed to protect our citizens, not open them up to fraud when they are unable to defend themselves or even understand the dangers that they are in.

A t the very least, you'd expect authorities to pay closer attention to the red flags, and with an operation this large, it's impossible that there weren't any. Sure, it's a tragedy that humankind is capable of such exploitation, but what are governments and institutions for? Regulations are meant to make these things impossible, or at least rare, but the only place you'll find productive policy is in a fiction bookstore online. If you buy Curing Medicare online through my nonfiction bookshop, you'll see that it's not the people but the system that needs to go.

pills on a white surface

Is Anybody In Charge?

Incredibly, a system isn't faulted for being a platform for fraud over and over. There are several reasons why Medicare fraud is prevalent in America:

Large Size and Complexity

The Medicare program is one of the largest and most complex government healthcare programs in the world, providing coverage for millions of beneficiaries. This complexity creates many opportunities for fraudulent activities to take place.

Lack of Resources

Medicare fraud investigations and prosecutions require significant resources, including trained personnel and advanced technology. However, the government often lacks sufficient resources to combat the scale of fraud committed by individuals and organizations.

High Financial Incentives

Medicare fraud can be highly profitable for those who engage in it, with estimates suggesting that Medicare fraud costs taxpayers billions of dollars each year. The potential for large financial gains provides a strong incentive for fraudsters to exploit the system.

Weak Enforcement

Enforcement of Medicare fraud is often weak, with many fraudsters going unpunished. This weak enforcement can create a culture of impunity, where fraudsters feel they can get away with their illegal activities.

Limited Oversight

The Centers for Medicare and Medicaid Services (CMS) oversees the Medicare program, but its ability to monitor and prevent fraud is limited. CMS relies on contractors and other organizations to help identify and investigate potential fraud, but these entities may not have the resources or expertise necessary to effectively combat fraud.

An ongoing surgery

Steal At Your Own Risk

With all of that information being out in the world, it's astonishing that the system has been left unchanged. You'd think that if there were even a handful of brain cells present, at some point, someone might have posited that Medicare needed some serious renovations. After all, lives are at stake. While it's been fumbled now and again, there's no reason to believe that this is something that the government or healthcare system is working toward.

If you browse a COVID-19 bookstore, it's not hard to see that money is the only thing that drives change in America, and too many people in positions of power benefit from rickety systems. The only argument that's sloppily presented in favor of Medicare is that it's better than nothing, but is it? What isn't being done is anything to protect the beneficiaries of Medicare.

A man peering through a microscope

I'm Andy Lazris, and if you have looked at my Civil War related books online and blogs, then the current state of affairs isn't as surprising. Three Brothers from Virginia is the story of love that persists in the face of unending cruelty, which is something we have to lean on as we put together our healthcare system.

For a lighter read, check out The Adventures of Yadel the Dreidel, a Jewish history book with a wonderful story. For more of the truth, tune into my podcast, or browse my online fiction book shop.

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