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Medicaid, Medicare and Other Fraud

What’s the difference between Medicare and Medicaid?

Medicare

Medicare is federal health insurance for people 65 or older, and some people under 65 with certain disabilities or conditions. A federal agency called the Centers for Medicare & Medicaid Services runs Medicare. Because it’s a federal program, Medicare has set standards for costs and coverage. This means a person’s Medicare coverage will be the same no matter what state they live in.

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Medicare-related bills are paid from two trust funds held by the U.S. Treasury. Different sources (including payroll taxes and funds that Congress authorizes) fund the trust funds. People with Medicare pay part of the costs through things like monthly premiums for medical and drug coverage, deductibles and coinsurance.

For more information, visit Medicare.gov.

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Medicaid

Medicaid is a joint federal and state program that helps cover medical costs for some people with limited income and resources. The federal government has general rules that all state Medicaid programs must follow, but each state runs its own program. This means eligibility requirements and benefits can vary from state to state.

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Medicaid offers benefits that Medicare doesn’t normally cover, like nursing home care and personal care services. People with Medicaid usually don’t pay anything for covered medical expenses but may owe a small co-payment for some items or services.

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Source: HHS

WHAT IS THE DIFFERENCE BETWEEN FRAUD AND ABUSE IN HEALTHCARE?

Healthcare fraud and abuse are often mentioned in the same breath, and they are sometimes used interchangeably. They are, indeed, related concepts, and the effects of each for patients and others may be difficult to distinguish. There are, however, important legal distinctions between the two concepts, including the potential penalties. 

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What is Healthcare Fraud?

Healthcare fraud is broadly defined as any deliberate and dishonest act committed with the knowledge that it could result in an unauthorized benefit to the person committing the act, or to another party likewise not entitled to that benefit. Healthcare fraud includes actions that are defined as fraud under federal or state law.

Common types of healthcare fraud include:

  • Billing for services never furnished

  • Falsifying medical necessity for a procedure

  • Fabricating medical records in order to justify payments

  • Falsifying eligibility

What is Healthcare Abuse?

Healthcare abuse concerns practices or incidents inconsistent with accepted and sound medical, business, or fiscal practices. When these practices result in unnecessary costs to Medicare, Medi-Cal, or other insurers, or result in reimbursement for services that are not medically necessary or otherwise fail to meet proper medical standards, they amount to abuse.

Comparing Fraud and Abuse

The difference between fraud and abuse often turns on the perpetrator’s intent. If the healthcare provider intentionally makes a false statement to another, such as by submitting a false bill to Medicare for services never rendered, and receives an unauthorized payment in return, they have committed fraud. If they engage in poor practices that are not deliberately false, such as maintaining shoddy billing practices, billing services at different rates to different carriers, or refusing to furnish or allow access to medical records, they could be guilty of abuse without committing fraud.

In practice, the harm to the insurer or government entity may be the same: overpayments and unjustified disbursements. Both can also give rise to whistleblower lawsuits.

Penalties for Fraud and Abuse

One principal reason that the distinction between fraud and abuse matters is because healthcare providers accused of each can face significantly different consequences. When someone is accused of healthcare fraud, the government can seek to exclude the responsible parties from certain programs (such as Medicare) or suspend their practice entirely, assess significant monetary penalties, and even seek criminal conviction under federal law. Perpetrators of healthcare fraud are liable to wind up in prison for their actions, should the government prove its case successfully.

Abuse, on the other hand, while still a concern, is considered a lesser offense. Typically, when abuse is discovered, the government will seek to recover any amounts paid in error, might assess additional civil fines, and could still suspend an abusive provider from programs like Medicare. Abuse can also give rise to civil liability from patients, insurance providers, and other individuals, but a criminal conviction is unlikely unless fraud is involved.

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Source: Law Offices of A.Kalantar

Why Fraud is Rampant in the Medical Industry

The History of Modern Medicine

Hippocrates, the Greek Physican, is referred to as the father of Modern Medicine. Perhaps, when one considers Modern Medicine Hippocrates is a good place to start. At the time of Jesus' coming Greek and Roman mythology as well as theocracy and philosophy were at their height. 

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However, before this era much of the mythology that their belief systems, including medicine, were based on begin far before this philosophical period in Greek & Roman history in the Egyptian and Mesopotamia skies with the study of astronomy and astrology as evident in the charting of stars, which they considered to be celestial entities (which they worshiped as gods and goddesses). This manifested itself in medical charting in patient 'medical history' as well as the scientific method, the approached used to chart the stars / celestial beings and make predictions regarding the gods, goddesses and indeed people's futures. 

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The significance of Jesus' has a huge impact on the political and socio-economic system of the Roman Empire as a consequence as many of their belief and government systems were based on such mythology, challenging popular religious beliefs including the budding Modern Medicine industry in which Hippocrates the Physican is credited with being the father of. In fact, Hippocrates rooted everything from the Hippocratic oath to visions of legal issues in the popular Mythology (religious beliefs) of the time, sighting goddesses such as Hygeia and Caduceus. One can see the manifestations of these gods and goddesses in the Hippocratic oath for it is these gods and goddesses that medical professionals today swear their oath by and to whom some of their if not most of their practices are based on and credited to.

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The simple reality is medical professionals today often do not discuss with their patients the religious belief system upon which their medical practice or profession is built. Rather they focus on the practice of this industry purporting concepts of neutrality like science and medicine.

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Understanding Medicine & Science relation to Non-Traditional Religion: Mythology & More

In Leviticus 19:26 it states: You shall not eat anything with the blood, nor practice divination or soothsaying.

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We share this scripture with you to highlight the difference between Non-Traditional (Organized) Religion such as Greco-Roman Mythology and other pagan faiths in relation to other Traditional Religions such as Christianity, Judaism or Islam, which have stark differences when it comes to practicing medicine or what may be considered Non-Tradional Religion rituals such as bloodletting (seeking youth).

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Medicine nor Science (what one can now see is rooted in such Non-Traditional Religious practices such as astrology and astronomy) does not, obviously, prohibit the practice of blood transfusions for whatever overt or covert purpose. However, Christianity is clear that one should not consume blood for it is the life of the being. So, one can clearly see here conflicts in practice and ritual, which are often not considered, disclosed, discussed much less adhered to or considered when one goes to a Physican regardless of beliefs or difference of belief systems there-in. Possibly from a lack of understanding their own faith clearly, discussions with religious leaders or from aggression in a medical industry that has become highly motivated by profit and increasing credited with forceful medical practices and tactics that disregard the wishes and religious beliefs of the patients they claim to serve in the spirit of health in life, however, which often lead to harm, sickness, illness, disease and death with covert intentions. 

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Understanding the Practice of Medicine and its relation to the practice of witchcraft and faith

Perhaps one of the clearest examples of the manifestation of medicine and science association with witchcraft and the faith in Non-Traditional Religions can in this example begin with disease vs. diagnosis. As Greco-Roaman Physican begin to practice Modern Medicine true to astrology one of the pillars of their practice was the scientific method, which they used to identify and confirm the presence of disease, which does indeed have evidence. Either a virus such as COVID-19 is present or not as a reflection of a test given to show its existence or not, which is beside the point of disease mongering and the fact that the prevailing theory is that COVID-19 came out of Wuhan, China as a biological weapon. Of consequence is the fact that Russia, a close ally of China, soon after begun its attack on Ukraine and began the Ukranian War which still prevails.

 

Diagnosis on the other hand is subjective and like the head of a person, which they also wanted to profit from, they detached themselves and in effect and to some degree the practice of such branches of medicine based on diagnosis rather than the presence of disease (such as psychiatry and psychology) from scientific proof and evidence. And it remains so today. Diagnosis is complete subjective based on no evidence and treated with medicines and practices that can claim zero efficacy without danger of making false claims.

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So, how does this relate to witchcraft and faith. The under-goddess Psyche is also associated with Greco-Roman Mythology and is the goddess credited with the branches of medicine such as psychiatry and psychology. Greco-Roman Mythology often sees their gods, goddess as practicing magic who are also as a matter of consequence considered witches and warlocks. In fact, those who practices these Non-Traditional religions often consider themselves as such. Namely and most modern, those of the pagan faith Wicca define themselves as witches and warlocks. Indeed, Mythology is not without its priests and high pretests. These persons may practice in small covens outside of medical facilities to their own physic practices, the simple truth remains all of these practioners are connected by the roots of the basis of Modern Medicine whether doctors like to admit to such or not.

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Often gods and goddesses from Athena to Psyche could have everything from temples erected in their name, to major goddesses such as Athena located through the Roman Empire, to Psyche with small statues scattered throughout the Roman Empire. Their followers often practiced within cults and implemented rituals and kept their temples and erected their statues to which they could be worshiped to. The question for the modern patient is where do these cult members exist within the medical and scientific industry? What do they believe? What do they practice? How does this impact you? Amongst your own questions.

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Modern concepts and beliefs regarding Medicine & Healthcare

In order to understand modern concepts and beliefs regarding medicine, healthcare and science, let us look at some historical and modern definitions that define these industries and the actions of their professionals and practioners.

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Many gods and goddesses relevant to Modern Medicine have been discussed. However, Aesculapius is the god of medicine and the son of Apollo, the god of healing, truth and prophecy. From Aesculapius and Hermes we get the staff of Aesculapius and the caduceus (see the symbols below). Both symbols or staffs are associated with medicine and are likely based on the staff Moses affixes with a snake when he heals his people while they are in the wildness freed from Egypt.

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health·care

health care (noun)

  1. the organized provision of medical care to individuals or a community

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med·i·cine

  1. the science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery):

    "he made distinguished contributions to pathology and medicine" · "the remarkable achievements of modern medicine"

    SIMILAR:

    healing

    therapeutics

    therapy

    treatment

    medical science

     

  2. a compound or preparation used for the treatment or prevention of disease, especially a drug or drugs taken by mouth:

    "give her some medicine" · "your doctor will be able to prescribe medicines"

    SIMILAR:

    medication

    medicament

    remedy

    cure

    nostrum

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    • healing substances or drugs collectively:

      "an aid convoy loaded with food and medicine"

  3. (especially among some North American Indian peoples) a spell, charm, or fetish believed to have healing, protective, or other power:

    "Fleur was murdering him by use of bad medicine"

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med·i·cal

ADJECTIVE

  1. relating to the science of medicine, or to the treatment of illness and injuries:

    "a medical center" · "the medical profession"

    SIMILAR:

    technological

    technical

    research-based

    factual

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    • relating to conditions requiring medical but not surgical treatment:

      "he was transferred for further treatment to a medical ward"

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sci·ence

  1. the systematic study of the structure and behavior of the physical and natural world through observation, experimentation, and the testing of theories against the evidence obtained:

    "the world of science and technology" · "science laboratories"

    SIMILAR:

    discipline

    field

    branch of knowledge

     

    • a particular area of science:

      "veterinary science" · "the agricultural sciences"

    • a systematically organized body of knowledge on a particular subject:

      "the science of criminology"

  2. ARCHAIC

    knowledge of any kind:

    "his rare science and his practical skill"

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These definitions give us some idea of modern concepts and beliefs of what the medical and scientific industries entail. What is missing is any connection to Mythology or their faith in Non-Traditional Religions and how they practice them since their industry as well as oath are rooted in them. Why is that? And what if your religious belief? How are your religious beliefs relevant to your health and the prayers you may or may not say to your God? How could this impact your health or the healing you may be seeking? Have you truly heard God on this matter? How? Is it scripture based?

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Manifestations of Disease Mongering, Marketing Lies & Warfare

In today's world one does not have to go far to see evidence of lack of efficacy in medical medicines, treatments and practice as proven by the Opioids and COVID-19 epidemic and pandemic respectively. 

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The opioids epidemic primary credited to Perdue Pharma pharmaceutical greed tactics more common than not. The epidemic is largely credited to marketing lies told to medical professionals such as doctors. Medical professionals were apparently told, and the drug was marketed as very low in addiction and an effective pain reliever. While this drug may have relieved pain, it was also highly addictive. Many patients spilled into street drugs also as a result of the addition fueling the statistics of incarcerated people with substance abusers as a result of the crimes that ensue to feed their addition. These additions, like opioids often, more than not, begin in the doctor's office with a mal-prescription driven by motives of profit. 

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The opioids epidemic has claimed more than 932,000 lives since 1999 according to the Center for Disease Control. 

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ep·i·dem·ic

NOUN

  1. a widespread occurrence of an infectious disease in a community at a particular time:

    "a flu epidemic" · "an epidemic of cholera"

    SIMILAR:

    outbreak

    plague

    scourge

    infestation

    pandemic

    epizootic

     

ADJECTIVE

  1. (of a disease) occurring widely in a community at a particular time. Compare with endemic, pandemic.

    "epidemic diseases" · "typhus was epidemic in the winter and spring of 1922"

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An epidemic typically is defined as a disease resulting in an excess of 15 cases per 1000,000 people for 2 consecutive weeks.

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pan·dem·ic

NOUN

  1. a widespread occurrence of an infectious disease over a whole country or the world at a particular time:

    "the impact of the pandemic caused loved ones to be separated and unable to meet in person" · "the results may have been skewed by an influenza pandemic" · "the coronavirus pandemic"

    SIMILAR:

    disease

    sickness

    bubonic plague

    pneumonic plague

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ADJECTIVE

  1. (of a disease) prevalent over a whole country or the world. Compare with endemic, epidemic.

    "pandemic diseases have occurred throughout history"

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A pandemic being larger than an epidemic in the number of victim's lives it claims.

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Is Fraud escapable in Modern Medicine?

Given the history of Modern Medicine the likelihood and obvious answer is it depends on what you believe. The fact and the evidence that the healthcare industry is riddled with more harm than good, disease mongering, under public and government scrutiny for this along with claims of monopolies and rising health care costs. 

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This is not the first time this industry that begin to bud into the Modern Medical industry as we know it today - has come under scrutiny by the public and the government. In fact, the FDA was created to protect the public from harm as the food and druge industries begun to emerge and people begun to go from growing their own food and home remedies to purchasing these products and services from the market.

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The FDA was created to protect the public from everything from spoiled food to snake oil prevalent around the railways of the west. However, it soon became corrupt riddled with staff accepting kickbacks and harnessed with conflicts of interest. For instance, the drug branch of the FDA is a board completely staffed with individuals connected in some way to the medical industry who are incentivized by fast tracking medications, drugs and treatments to the market rather than by the quality of the product or service or its efficacy. 

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The answer is thus No, Modern Medicine is likely hard-pressed to escape from fraud. One could likely characterize the Modern Medical industry as highly bloated, unnecessary and a harm to the public at large. While there may be few instances, cases, products or services of good to the public, likely it is far less than what exists and the answers of which, at least in the Christian faith begin in the scriptures. 

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afya nzuri ni juu ya utajiri / good health is above wealth

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Source: Shidonna Raven Garden & Cook

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Caduces and the Staff of Aesulapius Source Nature.png

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