I’m a retired surgeon. It baffles me how blatant cases of Medicare and Medicaid fraud—clear outliers— are not immediately audited.
In 2023 an ENT surgeon, Anita Jackson, who practiced at my hospital, a 100-bed facility in a rural NC county, billed Medicare $46 million between 2014 and 2018 for a balloon sinus procedure. In fact she was the nation’s top biller for this procedure! In little Richmond County. When finally audited, they found fraudulent medical records used to justify unnecessary procedures. Worse yet, they found she was rewashing these single use disposable devices. They weren’t sterilized. 36 catheters were used on 1,555 patients!
You would think every year that clear outliers would be audited. No AI needed here. It would have saved these patients from being exposed to unnecessarily and dangerous, in this case, procedures.
Spot on correct. This is why DOGE and Elon found so much thru simple data mining. This does not need to be gov employee staff, this needs to be delivered thru small incubator companies paid thru commission to find waste fraud and abuse
Spot on correct. This is why DOGE and Elon found so much thru simple data mining. This does not need to be gov employee staff, this needs to be delivered thru small incubator companies paid thru commission to find waste fraud and abuse
I’m a retired surgeon. It baffles me how blatant cases of Medicare and Medicaid fraud—clear outliers— are not immediately audited.
In 2023 an ENT surgeon, Anita Jackson, who practiced at my hospital, a 100-bed facility in a rural NC county, billed Medicare $46 million between 2014 and 2018 for a balloon sinus procedure. In fact she was the nation’s top biller for this procedure! In little Richmond County. When finally audited, they found fraudulent medical records used to justify unnecessary procedures. Worse yet, they found she was rewashing these single use disposable devices. They weren’t sterilized. 36 catheters were used on 1,555 patients!
You would think every year that clear outliers would be audited. No AI needed here. It would have saved these patients from being exposed to unnecessarily and dangerous, in this case, procedures.
She is currently serving 25 years in prison.
Spot on correct. This is why DOGE and Elon found so much thru simple data mining. This does not need to be gov employee staff, this needs to be delivered thru small incubator companies paid thru commission to find waste fraud and abuse
Spot on correct. This is why DOGE and Elon found so much thru simple data mining. This does not need to be gov employee staff, this needs to be delivered thru small incubator companies paid thru commission to find waste fraud and abuse