The most common type of codes that we use every day from postage to groceries are barcodes to
“ring up” sales on registers as items are passed through a scanner.
In some cases these provide a benefit including price changes More frequently since the shelf tags
require a person to change a price, those in the computer are higher than those on the shelf. It is
very time-consuming to check each item but anyone who shops for any consumable products know
they’re constant small fraudulent activities occurring. One of the main things barcodes do is order
product to replace the product that has been sold and measure market shares. Almost everything in
healthcare also have barcodes!
There are 64,000 ICD procedure codes with several codes averaging five codes. A deceitful or
careless practitioner can profit greatly from “up-coding” services. In the past butchers were known
to have pressed their fingers or thumb on a scale as they were weighing the meat they were selling
customers or making hamburger with a higher amount of fat than was listed on the label. When gas
containers showing gallons were replaced by gas pumps, gas stations would change the pump
calculator to sell less gas than paid for. when gas containers showing gallons were replaced by gas
pumps. Other examples include bars and restaurants which can water down liquors. The “water”
percentage means greater profits.
But deceitful use of healthcare codes in billing systems makes those fraudulent practices appear
small by comparison. If a physician or his billing clerk bills all procedures at high prices,
significant higher profits result. Commercial insurers are much, much better equipped to detect and
stop these practices, while Medicaid and Medicare really do not care about fraud as it is not their
money and they only act as go-betweens. And pharmacists dispensed drugs “repackaged and misbranded”
with the NDC codes of brand manufacturers, and none questioned this as if they didn’t know the sole
reason for NDC’s is safety!
Another egregious fraud is refilling prescriptions for patients who died or have stopped taking the
medication. There has been cases where generic drugs have been dispensed but billed to Medicaid
under the brand NDC increasing the profitability on the sale 5 to 10 times. I hasten to add that
this is an exception as most pharmacists do not and would not defraud all their customers on the
most popular drugs.
However, for two decades almost all pharmacists, chains and most independent pharmacies bought and
dispensed repackage drugs to make 10% to 20% more profit, fully aware they were bought at lower
prices consumers did not know of. Their wholesalers may have told them brand manufacture paid the
Medicaid rebates on them. However, Medicaid records show they did not. The result was that
taxpayers paid list price for these drugs…totaling $57 billion over 20 years!