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Kickbacks and Fraud in Our Health Care System

Shidonna Raven Garden and Cook. All Rights Reserved. Copyright.

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Photo Source: Unsplash, Mufid Majnun



A large overlooked population rife with fraud under the 'care' of the western medical industry are the disabled. Similar to other managed disease kick backs are received from the government and effectively turn the so called disabled into patients often for life. Let us first pause and look at the modern concept of managed disease. The goal of managing medicine and disease is the aim of keeping people perpetual patients so that the medical professional can often reduce the time, if any spent with the patient and receive continuous payments from the perpetual patient. The goals is not to heal or cure the patient but rather to secure a consistent long term income and likely at the maximum amount.


The issue with leaving one in a constant state of disease, an unnatural state for the body, is the rising morbidity and mortality rates. In fact health insurance companies have been clear that rising health care costs in insurance are in part due to chronic disease i.e. manged medicine / managed disease. Essentially they have to pay out more. Often the so called disabled and other chronically ill patients are victims of disease mongering rather than victims of disease itself. In fact, one patient was given medication / drugs unnecessarily. However, the side effects of the drugs / medication were diagnosed to - in thus producing the illness. The same approach is applied to patients who smoke cigarettes or otherwise take street drugs.


Consequently, the 'disabled' often if not always are a huge market of chronically ill people - fraudulently so or through disease mongering, which provide the perpetual paycheck through the perpetual patient. Surrounding these patients are several forms of referral and non-referral kick backs that can begin in schools or colleges from professor to peer as those who are in schools and colleges are not above accepting or preparing to accept kickbacks and setting themselves up based off of the medical history of fraud and kickbacks already plaguing the family in the name of "genetics".


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The health care industry in the United States is plagued by fraud, abuse and waste. In fact, it costs us up to $60 billion every year. People often think of fraud as being identity theft or fraudulent billing practices, and while those things are certainly a big problem in our current system, fraud often occurs in the form of “kickbacks.” Kickbacks are arrangements made between providers in which one party refers patients to another through services, goods or medicines. Let’s look at a scenario that might be classified as a kickback. You go see your doctor for a lingering cough and your doctor prescribes you a new medicine that will help suppress your cough. So far, so good. But after doing some of your own research, you find that the medicine isn’t primarily a cough suppressant. It is intended to treat other things and may or may not improve your condition. You talk to a friend who went to the same doctor with a different problem and discover that the doctor also prescribed the same medicine for their condition. In this hypothetical, the physician is giving out medicine not to treat their patient’s condition, but because they are receiving payments from the company that makes the drug. The more prescriptions that doctor writes for the drug, the more money they’ll get from the company. This is called a kickback, and it’s easy to see why such an arrangement would be considered illegal. Healthcare providers are supposed to offer tests and treatments based on their knowledge of and experience, not because of financial incentives from other providers or companies. When they are motivated by kickbacks, providers make decisions that are not in the best interest of patients. That is the motivation behind our country’s anti-kickback laws. Two U.S. laws prohibit kickbacks in the healthcare industry - the Anti-Kickback Statute and the Stark Law. According to the Office of the Inspector General, the AKS prohibits the “knowing and willful payment of ‘remuneration’ to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs.” The Stark Law is the nickname for the Physician Self-Referral Law. The OIS says that the Stark Law prohibits “physicians from referring patients to receive ‘designated health services’ payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.” The AKS covers arrangements in which payments or benefits are given to providers for making a referral, while the Stark Law prohibits providers from engaging in practices that benefit their own bottom line because of an investment or stake they might have in the referring entity. Essentially, these laws seek to rid our health care system of conflicts of interest. But kickbacks are still a common form of fraud. At the beginning of 2017, USA Today reported that several doctors, pharmacy owners and marketing professionals are accused of a kickback scheme involving a fake medical study. The study was allegedly used by the accused parties to receive “up to $102 million from the publicly funded federal health program for military family members.” In another example, Walgreens was recently held accountable for a kickback scheme, agreeing to pay back $50 million for a influencing government health care beneficiaries to get their prescriptions filled at Walgreen’s stores. The settlement was the result of a joint effort by the government and a private whistleblower. Whistleblowers, often employees of fraudulent providers and companies, are an important part of the fight against fraud. By coming forward with information about the wrongdoing within their company, a whistleblower provides the government with important details regarding the fraud they’ve witnessed. To understand just how important they are, let’s revisit the hypothetical scenario we discussed earlier. When patient follows a provider’s advice about a good or service, they have little to no way of knowing their provider’s motivation. When you went to the doctor for a cough and they gave you a prescription, it was only after doing your own research and a chance conversation with a friend that you discovered something wasn’t quite right. To know that the doctor was prescribing medication as part of a kickback, you’d likely need to work alongside that doctor and to have seen the kickbacks firsthand. That is why whistleblowers provide a much-needed service; they are the ones who witness the fraud and can provide investigators evidence that fraud has occurred. The U.S. health care industry is a complex system, which involves many players and a whole lot of money. That makes it vulnerable to fraud, abuse and waste. Stopping kickbacks is part of the effort to make sure that patients receive care based in rational decision-making by their providers, not by personal financial motives.



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