Medical fraud - can whistleblowers benefit financially?

Quote from z2g : I think it depends on the procedure. But for the most part, Medi-Aid pays very little. MediCare pays decently. For example, I get paid only $40 for a comprehensive eye exam with dilation! Even at a Costco Optometry office, the doc gets paid $49 plus $25 for the exam and dilation. And, when the Medi-Aid patient gets eyeglasses, I only get paid $18 for my frame which I normally sell for about $40. And, I only get 18 for the ophthalmic lens dispense which is at least half of what I would normally profit on lens purchases. Total for the patient with an eye exam and eyeglass purchase, I grossed a little under $80.....and that doesn't include my cost for that eyeglass frame. Hence, if I only saw Medi-Aid patients, I would have to examine A LOT more patients per day to make a profit and pay my overhead. For a $100 ocular emergency visit, I get paid $80 by MediCare....so not bad.

It is dependent on the State one lives in, as to how much Medicare/Medicaid pays. I know for the Eye Doctor my FIL goes to and I'm looking at the CMS Medicare Summary Notice right now; the Doctor Charged $145 for the exam, Medicare Approved $125.36, and they paid $100.29 to the Doctor, with the remaining being paid of $25.07 by Supplemental Insurance. That was for the Eye exam and treatment - he has a hole in one retina, and a cataract in the other eye. There is another line of billing for Special Eye Exam, subsequent, and the Amount Charged was $40, Medicare Approved $24.31, and Medicare Paid $19.45, with the remaining being paid of $4.86 by Supplemental Insurance. So the Eye Doctor was paid a total of $149.67 out of billing $185.00. His loss was $35.33. And, we are charged $40 if he writes out a script for eye glasses, as that is not covered, nor are the glasses themselves. That is on us; which cost us well over $400 for the glasses out-of-pocket.

See how different things are from State to State with Medicare/Medicaid. You cannot not base what you receive from Medi-Aid/Medi-Care as you call it, in your State, with all other States; as it differs from State to State with how it is billed and paid; by my example.

If I go to the Eye Doctor, I am charged nothing with my Insurance; but if I had to pay for it myself, it would only be around $85.00. Big difference, isn't it

Patients with Medicaid/Medicare are being charged more by Doctor's, than Patients with regular Insurance; as I see my bills vs my FIL's bills at the same Doctor's office.

Someone has some explaining to do, and it's the Doctor's who are doing the billing here People complain that Medicare/Medicaid is going broke; that is a perfect example of why; the difference in billing between a regular patient and a Medicare/Medicaid patient.

Considering I'm with him at every visit, I know how long the visit is, and exactly what goes on at each visit as well.