Healthcare fraud tends to be “under the radar” for most of us, surfacing when authorities arrest those accused of such behavior or when guilty verdicts are announced and usually in stories buried on the inside pages of the newspaper.

            While it is widely acknowledged to be a serious problem, costing the government and private insurers tens of billions of dollars, it is very hard to get factual data. The numbers that reach the press are of perpetrators who are caught. The number of schemes that go undetected is impossible to quantify.

            It is also a worldwide problem, not just a North American issue. The National Academies estimated in 2018 that of the $7,350,000,000,000 spent globally on health care, some $455,000,000,000 was lost to fraud. Investigators in China estimated that in 10% of healthcare spending, there was waste due to fraud.

            Fraud can take many forms. The most obvious is to bill insurers for services not rendered. A New York-based cardiologist was arrested for billing Medicare and Medicaid $1,300,000 for Covid testing that was never done.

            More commonly, billing can be done for expensive services and equipment that are unnecessary. Companies “cold-call” people and offer braces and electric-lift chairs that will be “free” if their doctor authorizes them. One brazen scheme involved gathering homeless people who were on Medicaid and paying them small sums to go to a testing center for a panel of totally pointless but expensive tests for fabricated diagnoses.

            Twelve physicians in Ohio and Michigan were sentenced to prison last year for a scheme that required narcotic addicts seeking prescriptions to undergo spinal injections, which are richly reimbursed, before getting their prescriptions.

            More subtle and more widespread is “up-coding,” providing a service but billing for a more expensive one. Take the office visit. Billing for such visits can be done at one of five tiers based on the complexity of the problem and time needed to deal with it. The higher the level, the more the payment. A Massachusetts orthopedic surgeon was charged in March of 2022 for billing top-level visits for as many as 90 patients a day – meaning that in one workday he was claiming to do over 60 hours of care! To a lesser degree, this practice is very widespread.

            Technology has unfortunately made fraud easier. The typical electronic medical record allows the user to populate a note with detailed history and physical finding with a few clicks, whether or not these were done.

            Telemedicine, a boon for many during Covid lockdowns, also provided a fertile field for the unscrupulous. One of “America’s Frontline Doctors,” the headline-grabbing vaccination deniers, lost her license for providing ivermectin and hydroxychloroquine after one- to two-minute online visits for which she billed $90. Telemedicine visits for addiction counselling are supposed to last 45 minutes. The Recovery Connection Centers of America billed insurance programs millions of dollars for visits that lasted an average of five minutes, federal authorities alleged last month.

            Why should you care? Ultimately, whether through taxes or health-insurance premiums, it is your money that is being wasted. When you suspect fraudulent billing, report it.

            Dr. Ed Hoffer is the chairman of the Marion Board of Health, a graduate of MIT and Harvard Medical School. He is Associate Professor of Medicine, part-time, at Harvard and a Senior Scientist at the Massachusetts General Hospital.

What Does The Doctor Say?

By Dr. Ed Hoffer

Superintendent Michael S. Nelson and Principal Silas Coellner are pleased to share that six Old Rochester Regional Junior High School students participated in the Southeastern Massachusetts Music Educators Association Junior District Festival (SEMMEA) on March 8 and March 9.

            The two-day festival was hosted at New Bedford High School. Students from the MMEA Southeastern District participated in the festival after initial auditions were held in December 2023. Family members, friends and districts’ faculty attended the festival in support of student participants.

            In attendance there were five ensembles made up of approximately 375 musicians in Jazz Band, Treble Chorus, Mixed Chorus, Orchestra and Concert Band.

            “We are extremely proud of every student who participated in the festival this past weekend,” Principal Coellner said. “They have spent significant time practicing and it’s great to see their hard work pay off!”

            Concert band eighth-grade students Brianna Cabral (clarinet), Mara Donnelly (flute), Isabella Perez-Dormitzer (voice), Erin Root (voice), Rebecca Schaefer (trumpet) and seventh-grader Sophie Zhou (trombone) participated in rehearsals for two days before performing in a public concert.

            “I am incredibly proud of the dedication and talent our musicians displayed at the recent SEMMEA Junior District Festival,” said Instrumental Music Teacher Richard Laprise. “Their hard work and commitment truly paid off with phenomenal performances that resonated with the audience. They are a shining example of the musical excellence we strive for at Old Rochester, and they represented our school with great distinction.”

            “I would like to congratulate Brianna, Mara, Isabella, Erin, Rebecca and Sophie on their performances,” said Superintendent Nelson. “This is a great achievement for all involved, including our dedicated music teachers and the families of our students who have provided their support and encouragement.”

            The Massachusetts Music Educators Association (MMEA) has approximately 1500 members and provides leadership in professional development, advocacy, student assessment, opportunities for students and providing a comprehensive, quality music for all students. MMEA is divided into five districts with a chair and an executive board for each district. Each of the districts organizes honor ensemble festivals and general music events. A percentage of students who participate in district festivals are eligible to audition for All-State honors ensembles.

I heard that some politicians who probably never served in the military are talking about bringing back the military draft. In the spirit of transparency, I did not serve in the military, but not for lack of trying. My father had given me six months to get a job or get married after college. With no prospects for marriage in sight, I started looking for a job, or the draft would soon be my employer.

            My friend Bob and I were the top two in our design class so it should have followed that we would have our picks of jobs after graduation. We both interviewed at one of the top design firms in the country, and it was in Boston. The owner hobnobbed with the likes of F. Lee Bailey, the famous attorney who later got O. J. Simpson off the hook and had his own helicopter. Impressive stuff. This guy, who saved O.J.’s behind, could certainly save mine from Dad or marriage or the draft.

            My interview was with his chief designer. I thought things went well, but I did not get the job, and neither did Bob. Another friend who was last in our class did. Years later, I went to work for that chief designer, who had left the highfalutin firm to start his own firm, and he told me we didn’t get hired because they liked to “mold” new designers in the boss’s image, and “Mr. Irrelevant” (a football term for the last player chosen in another draft) could be paid less.

            No design firms were begging for my services so just before graduation Bob and I and another friend Carl marched to South Station in Boston to the Army/Navy/Air Force joint recruiting station to see what our options were. Bob and Carl signed up for the Army. I opted for the Air Force. I fantasized that I might land a nice, cushy assignment at an airfield in the Bahamas mowing golf-course greens as another friend had the year before.

            The enlistment physical was at the infamous Boston Army Base, where endless lines of young men suffered the embarrassment of standing naked in the freezing exam area with hundreds of other recruits for what seemed like hours. (What is it they say about the Army, “hurry up and wait?”) Alas, at the end of the day, I was told that because of my eyesight the Air Force did not want me.

            Graduation arrived, after which I retreated to Mattapoisett, my deferment expired, to await my call from the Selective Service’s version of “Nurse Ratched,” Mrs. Stonkas, the head of the Middleboro Draft Board. Not long after, the official letter arrived. Back to the Boston Army Base for another round of prodding, poking and penetrating, subsequently to be notified that I had failed that physical as well. Confident that I could go on with my life, I began searching for employment … again.

            Yup! Another letter arrived. Back to Boston, hoping it was all a mistake since I had already failed two physicals. This time I passed!

            Back to Mattapoisett, to wait to be drafted into the United States Army. Surprise! Another letter arrived “inviting” me back to Boston for a fourth round of P.P.P. Upon arrival, I was greeted with “Are you back again?” or “Couldn’t stay away, huh?” I was now on a first-name basis with the prodders and pokers.

            This exam, including an ophthalmologist and a couple of other “gists,” resulted in my being told that my eyes were bad (no kidding!) and my albumin was dangerously high (who knew what albumin was). This time I failed for good. But, they said, I should see my personal doctor immediately.

            Dr. York, from whose wife I bought my first car, had me pee in a cup every day for a week. He declared I was fine. Who was I to question the good doctor? (He got shaves from my dad, his barber, every week, which may have influenced his diagnosis.) I was not “sick” again for 35 years.

            After basic training, Carl was sent to Army Graphics School where he worked his tail off, assuming that would get him a safe assignment somewhere stateside. He graduated first in his class and was sent to Vietnam where, he insisted, he painted naked women on airplanes.

            Bob followed Carl to Graphics School a week later. Assuming it didn’t matter how well he did, he graduated near last in the class. He spent his whole time during the war driving a Triumph convertible around London, England. I spent the rest of the war corresponding with them and feeling guilty.

            Carl came home with a Silver Star, married a piano teacher, had eight kids ranging in age from 21 to four-year-old twins and died of cancer at age 50. I ran into Bob years later in a Walmart parking lot. He had pure white hair and sported a long white beard. I was married and finally had a job.

            Editor’s note: Mattapoisett resident Dick Morgado is an artist and retired newspaper columnist whose musings are, after some years, back in The Wanderer under the subtitle “Thoughts on ….” Morgado’s opinions have also appeared for many years in daily newspapers around Boston.

Thoughts on…

By Dick Morgado

Marion Town Administrator Geoffrey Gorman, Police Chief Richard Nighelli and Harbormaster Adam Murphy are pleased to share that the Marion Harbormaster’s office, a division of the Marion Police Department, has launched a new online database.

            The Town of Marion has contracted with Town Moorings to create a user-friendly online platform, which launched on March 8, to modernize and streamline the billing process. This platform also serves as a way to broadcast messages to the entire Marion boating community, such as harbor updates and storm warnings.

            “We look forward to implementing electronic account viewing and payments through this system for the convenience of our residents and our boating community,” said Town Administrator Gorman.

            Current permit holders will receive a welcome letter with a link that will direct users to create a username and password. In the coming days, if you are not a permit holder you will be able to create an account by visiting marion-ma.townmoorings.com.

            The platform provides users with an easily accessible electronic payment system and the ability to self-manage their personal and vessel information. Users will also have access to the mooring waitlist sign-up, mooring relocation application, boat increase forms, boat berth and kayak waitlist sign-up. This platform allows commercial marinas to manage all of their customers’ mooring permits to ensure accurate data for all vessels moored or stored within the Town of Marion.

            In the coming weeks, mooring inspectors will be able to update mooring permits as inspections are done. This will help streamline the inspection process and prevent late fees for late inspections. One of the most exciting functions added will be the pump-out requests. This function will capture an accurate accounting of the vessels being pumped out, and the boat owner will receive an email receipt when the services are completed.

            Permit holders can expect to receive an email with their invoices. A mailing will also be sent this year to ensure the invoices are received. If you receive an invoice by mail only, the department asks you to please update your information to verify the correct email address. Payments can be made online or by mail.

            Permit-holder payments were due on May 15.

            The information on file for current permit holders has been transferred to the new database. If any information is incorrect or outdated, permit holders are encouraged to contact the Harbormaster’s office at 508-748-3535.

            In 2023, the Marion Harbormaster became a division of the Marion Police Department following new legislation — the Police Accountability and Oversight System — by the Baker-Polito Administration. On Oct. 3, 2023, Officer Adam Murphy was appointed as Harbormaster following the recommendation of Chief Nighelli to the Select Board.

            “This new platform will streamline the process for our permit holders to electronically manage their accounts and will create an efficient way for our department to track mooring obligations, invoices, permits and more,” Harbormaster Murphy said.