Suprised more folks aren't talking about the $46M settlement

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Anonymous said:
It will be great when the people on here get a job; instead of having nothing better to do to then spread lies, rumors and BS. The more you get on here and commit destructive acts it's another chalk mark that will come back to you at some point in time. It's called KARMA. You might not see it today but it will rear it's ugly head in the future. COUNT ON IT.......If you would just take your negative energies and put them towards finding a job, you might be able to get one. The more you get on here and do what your doing the more unlikely you will never find a job and will continue to be the miserable person that you appear to be.
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it sounds like YOU are the one putting negativity on this thread!!! You must be sitting pretty in executive row - reaping in the money yet scared to truly be upfront and forthright and do something about this mess!!!
 






Anonymous said:
It is also interesting to note that DOJ and Medicare have every opportunity to stop this overbilling and get their money back and do not do it. Are the lobbys so strong or the lawyers so connected? Is Medicare too embarrassed? How can this be continued knowing this product is skeptical clinically and definitely being overbilled fraudulantly? A billion here and a billion there, they could save some real money to the taxpayers and the system. Why isn't some Senator jumping on this?
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Because Medicare doesn't but should have contractual obligations in place, just like the Private Insurance companies do. The system is based on trust and it's companies like yours that spoil that trust by over billing for your product as well as changing dates on forms, using the wrong codes, etc. If I were Medicare, I would DEMAND that the manufacturers set up their product for RENTALS. Nonsense for a purchase to be made on these items. I am seeing an increase of surgeons asking their patients to bring in their stims after use. Then they recycle them on new patients. Can't blame them for trying to cut costs to Medicare and co=pays to patients. All the companies need to clean up.
 






Anonymous said:
Because Medicare doesn't but should have contractual obligations in place, just like the Private Insurance companies do. The system is based on trust and it's companies like yours that spoil that trust by over billing for your product as well as changing dates on forms, using the wrong codes, etc. If I were Medicare, I would DEMAND that the manufacturers set up their product for RENTALS. Nonsense for a purchase to be made on these items. I am seeing an increase of surgeons asking their patients to bring in their stims after use. Then they recycle them on new patients. Can't blame them for trying to cut costs to Medicare and co=pays to patients. All the companies need to clean up.
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Why can't the companies take the first step? Check Ebay, 50 BGS for sale and barely used. This is a travesty of the Medicare system and gov't workers should be fired, just as they would in private industry if they make a billion dollar mistake. And they keep paying....does not even meet the new clarified definition of DME, where it must be rentable and last 3 years. SOMEONE STOP THIS MADNESS
 






I would love to work for Medicare....I would send all of you companies to the cleaners and only do business with DME companies who rent. "Oh, your not set up for rental you say, Well you better get Set up for Rental if you wanna do business with me".
Plus, I would demand all of the vendors have a representative call on me and persuade you to lower prices OR else initiate BIDS for an exclusive contract. 1 Stim for Long Bones and 1 Stim for Spine. I would have to throw DJ's out because it is so low in efficacy that most people require additional surgery after it's use. I'd most likely throw out the EBI and the Implantable as well since the technology is obsolete and the studies are poor. The only thing that keeps an EBI rep going is if they have been in the territory a while and have "bought" the Dr.
 






Some may argue that it's infringement on Capitalism but I argue that Medical Device and Pharmaceutical companies are taking the Tax payers to the cleaners.

Nothing wrong with the Bidding Process and I think Medicare should do it, just like the Commercial Insurances Do.
 












Anonymous said:
so what's the latest on this? Any blacklisting with federal programs? Been very quiet over the last few weeks
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Like most of these embarassments which happen to be on both sides of this sad saga of Medicare overpaying and companies overbilling and it continues on and on, will try to be swept under rug and business as usual....somebody call the media....this is $125M a year being thrown away
 






sorry whistle blower.......Medicare just paid thousands of claims for purchase today to all the BGS companies and has been every day for the last 30 yrs. If it was an issue you can bet it would have stopped 24 months ago......
 






Anonymous said:
sorry whistle blower.......Medicare just paid thousands of claims for purchase today to all the BGS companies and has been every day for the last 30 yrs. If it was an issue you can bet it would have stopped 24 months ago......
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Wrong....just an accredited HME provider who sits through hours of meetings without pay for associations trying to work with CMS to weed out the bad apples and improve the system. NAMES, V.P.Council of SNF Suppliers, and 35yrs Medicare billing. BGS does not even meet the new definition of "durable" which I am sure you have reviewed, since all you ortho reps are so well versed in Medicare law. This will stop being paid as currently being reimbursed....you have motivated me to do something about it. I'm mad as hell, and I'm not going to take it anymore.
 












Anonymous said:
ok whistle blower. until u r able to save the world...Medicare just approved purchase for a thousands more BGS that is helping save millions in failed fusions.
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You are barking up the wrong tree. Noone is against the use of BGS if the doc thinks it may help, even thought the evidence of its usefulness is wafer thin if any at all. It certainly causes no harm. The issue is some manufacturers refusing to offer rental as an option when most patients will only wear the device for 2 months on average. The manufactured cost is around $ 50 and the end user price ranges between $ 3,000- $ 5,000. This is what is called profiteering and a rip off and Medicare are also to blame for paying rip off prices without due diligence. Taxpayers and the public pay for the rip off.
 






While your at it please address pedicle screws and plates that cost 25 cents that sell for $1,000. Or back braces that cost $20 bucks that sell for $700 or more. Or how about pacemakers that cost maybe $100 and sell for $10,000. Maybe you can also check into hip replacements that cost $40 and sell for $6-8k. Also make sure you also solve dorsal column stimulators that cost $75 bucks and sell for $10K. While you are at it can you solve the Gov't irresponsible governing and mismanaging our countries finances by over spending and putting our country at risk by running up $14 trillion in debt. Oh can you also handle and police CPAP devices that cost $30 and sell for $800. All of these are each are billion dollar plus expenses compared to BGS $100 million. Put on your superman cape and focus on something that will make a difference. Oh..... I forgot as a whistle blower u r hoping to cash in on rental Vs purchase.
 






Anonymous said:
While your at it please address pedicle screws and plates that cost 25 cents that sell for $1,000. Or back braces that cost $20 bucks that sell for $700 or more. Or how about pacemakers that cost maybe $100 and sell for $10,000. Maybe you can also check into hip replacements that cost $40 and sell for $6-8k. Also make sure you also solve dorsal column stimulators that cost $75 bucks and sell for $10K. While you are at it can you solve the Gov't irresponsible governing and mismanaging our countries finances by over spending and putting our country at risk by running up $14 trillion in debt. Oh can you also handle and police CPAP devices that cost $30 and sell for $800. All of these are each are billion dollar plus expenses compared to BGS $100 million. Put on your superman cape and focus on something that will make a difference. Oh..... I forgot as a whistle blower u r hoping to cash in on rental Vs purchase.
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I am not a whistle blower for profit, I am not out to make any money on this.

First, I have some doubt about some of your figures like it costs 25 cents to manufacture pedicle screws and plates. This is garbage. Even the raw material costs a lot more than that.

Second, a thousand wrongs by others do not make it right for anyone else to do wrong as well. It's like saying: I have done wrong but it doesn't count because the jail is full of a million other wrongdoers.
 






Anonymous said:
Why can't the companies take the first step? Check Ebay, 50 BGS for sale and barely used. This is a travesty of the Medicare system and gov't workers should be fired, just as they would in private industry if they make a billion dollar mistake. And they keep paying....does not even meet the new clarified definition of DME, where it must be rentable and last 3 years. SOMEONE STOP THIS MADNESS
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from a former rep- one big problem and the easiest fix in my opinion isn't necessarily the rental vs purchase issue, but the simply OBSCENE profit we made off some managed care providers. Look at your buy and bill programs with your larger ortho clinics: we sell the units ( and make quite a nice profit) for around 1600-1700 a piece. However, those same units are sold to workers comp for over 4000 a piece. and medicare for well over 3000 a piece ( maybe closer to 3500? sorry it has been a while)! how on earth is that allowed to happen???!! why isn't the unit sold for 1600 to everyone?

Companies need to be profitable, we all understand that but this is just wrong.

also, some have commented on the buy/bill programs. again, obscene. clinics making sometimes 2500 dollars off of the insurance companies on one patient by buying @1600 and billing for 3500-4500? how the HELL is that still going on after so many years? I mean it was good to be a rep back in the day but people at O-FX and the other stim co's need to go to prison for what they are doing. not to mention the dr's prescribing these so they can make these kind of profits profits for doing so.
 






Anonymous said:
from a former rep- one big problem and the easiest fix in my opinion isn't necessarily the rental vs purchase issue, but the simply OBSCENE profit we made off some managed care providers. Look at your buy and bill programs with your larger ortho clinics: we sell the units ( and make quite a nice profit) for around 1600-1700 a piece. However, those same units are sold to workers comp for over 4000 a piece. and medicare for well over 3000 a piece ( maybe closer to 3500? sorry it has been a while)! how on earth is that allowed to happen???!! why isn't the unit sold for 1600 to everyone?

Companies need to be profitable, we all understand that but this is just wrong.

also, some have commented on the buy/bill programs. again, obscene. clinics making sometimes 2500 dollars off of the insurance companies on one patient by buying @1600 and billing for 3500-4500? how the HELL is that still going on after so many years? I mean it was good to be a rep back in the day but people at O-FX and the other stim co's need to go to prison for what they are doing. not to mention the dr's prescribing these so they can make these kind of profits profits for doing so.
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so WHO WILL GO TO PRISON????????
 












No one is right.
When confronted, the company will blame it on the ortho clinic who is doing the direct billing, even though it was of course the company that showed them how to do it and set the buy-bill program up in the first place.
 






Anonymous said:
Probably nobody. Big biz and DOJ make deals and CMS off the hook. Taxpayers flip the bill. It would not surprise me that a public corruption case is filed soon, as this fraudulant billing is so obvious it just has to be stopped.
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Since all DME is patient choice, and the choice is always a more expensive purchase, it does not appear a choice is being given. This is not simply a supplier standard #5 being violated, the supplier manual under section 2100 requires it. Companies accepting assignment on their claims have to follow these rules, unless these companies have a special exemption, which I doubt. This is medical billing 101. Purchase only companies can not accept assignment, but must bill patient for the overutlization. THIS IS THE LAW. IT IS WHAT ALL HME PROVIDERS MUST FOLLOW. Reviewing this blog, this situation is out of control. Typical government incompetence.
 






Anonymous said:
Since all DME is patient choice, and the choice is always a more expensive purchase, it does not appear a choice is being given. This is not simply a supplier standard #5 being violated, the supplier manual under section 2100 requires it. Companies accepting assignment on their claims have to follow these rules, unless these companies have a special exemption, which I doubt. This is medical billing 101. Purchase only companies can not accept assignment, but must bill patient for the overutlization. THIS IS THE LAW. IT IS WHAT ALL HME PROVIDERS MUST FOLLOW. Reviewing this blog, this situation is out of control. Typical government incompetence.
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It is not just incompetence on the part of the government, but also on the part of private insurance companies. As a consumer that pays an incredible amount of money for my family's health plan, it is disgusting to know what kind of profits WE are paying for. I suggest anybody who cares about this writes a letter to their insurance company.
 






Anonymous said:
It is not just incompetence on the part of the government, but also on the part of private insurance companies. As a consumer that pays an incredible amount of money for my family's health plan, it is disgusting to know what kind of profits WE are paying for. I suggest anybody who cares about this writes a letter to their insurance company.
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I suggest the same. Then we will all lose our jobs. Policies will tighten as well they should.
 






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