Loophole in Medicare Allows Unlicensed Doctors to Continue to Practice

“The first time cardiologist Robert Graor lost his Ohio license to practice medicine was in 1995, after he was convicted of 10 felony theft counts for embezzling more than $1 million from the Cleveland Clinic and sentenced to three years in jail. The second time was in 2003, after he’d won back the license following his release from prison. This time, the Ohio Board of Medicine found he repeatedly misrepresented his credentials over a two-decade period and permanently barred him from practicing medicine. That didn’t stop Graor from participating in Medicare, the government’s health insurance program for the elderly and disabled. In 2012, Medicare paid $660,005 for him to treat patients in New Mexico, which gave him a license to practice in 1998. Graor declined to comment.” That’s how Bloomberg News (reported by the Chicago Tribune) opened its article on how previously suspended and unlicensed doctors have used a Medicare loophole to continue to practice medicine and bill the federally-funded program.

According to the article, at least seven doctors have been identified as practicing medicine in similar fashion and reaping the rewards to the tune of $6.5 million. For the first time in more than 30 years, the Centers for Medicare and Medicaid Services have released information regarding its payments to doctors for services rendered. In its report, $44 billion was determined to be the result of fraudulent or improper billing errors. “That’s ridiculous,” says Sidney Wolfe, a physician who founded Public Citizen, a Washington consumer-advocacy group. “If a doctor is thrown out of one state, that should be enough to exclude them from Medicare.” It may be ridiculous but it’s happening every day and the system has no effective way to stop it.