Are you aware of this? It's outragious

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Wiseacre, Aug 2, 2011.

  1. Wiseacre
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    Wiseacre Retired USAF Chief Supporting Member

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    Wanna save nearly a trillion bucks over the next 10 years? Here ya go. Why we aren't working on ways to reduce this is beyond me.


    Entitlement Bandits - Michael F. Cannon - National Review Online

    " Consider some of the fraud schemes discovered in recent years. In Brooklyn, a dentist billed taxpayers for nearly 1,000 procedures in a single day. A Houston doctor with a criminal record took her Medicare billings from zero to $11.6 million in one year; federal agents shut down her clinic but did not charge her with a crime. A high-school dropout, armed with only a laptop computer, submitted more than 140,000 bogus Medicare claims, collecting $105 million. A health plan settled a Medicaid-fraud case in Florida for $138 million. The giant hospital chain Columbia/HCA paid $1.7 billion in fines and pled guilty to more than a dozen felonies related to bribing doctors to help it tap Medicare funds and exaggerating the amount of care delivered to Medicare patients. In New York, Medicaid spending on the human-growth hormone Serostim leapt from $7 million to $50 million in 2001; but it turned out that drug traffickers were getting the drug prescribed as a treatment for AIDS wasting syndrome, then selling it to bodybuilders. And a study of ten states uncovered $27 million in Medicare payments to dead patients.
    These anecdotes barely scratch the surface. Judging by official estimates, Medicare and Medicaid lose at least $87 billion per year to fraudulent and otherwise improper payments, and about 10.5 percent of Medicare spending and 8.4 percent of Medicaid spending was improper in 2009. Fraud experts say the official numbers are too low. “Loss rates due to fraud and abuse could be 10 percent, or 20 percent, or even 30 percent in some segments,” explained Malcolm Sparrow, a mathematician, Harvard professor, and former police inspector, in congressional testimony. “The overpayment-rate studies the government has relied on . . . have been sadly lacking in rigor, and have therefore produced comfortingly low and quite misleading estimates.” In 2005, the New York Times reported that “James Mehmet, who retired in 2001 as chief state investigator of Medicaid fraud and abuse in New York City, said he and his colleagues believed that at least 10 percent of state Medicaid dollars were spent on fraudulent claims, while 20 or 30 percent more were siphoned off by what they termed abuse, meaning unnecessary spending that might not be criminal.” And even these experts ignore other, perfectly legal ways of exploiting Medicare and Medicaid, such as when a senior hides and otherwise adjusts his finances so as to appear eligible for Medicaid, or when a state abuses the fact that the federal government matches state Medicaid outlays. "
     
  2. uscitizen
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    uscitizen Senior Member

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    As I have been saying all medicare fraud cases should automatically have a 200% of the fraudlent billing as a fine in addition to any prison time, etc.
    This would prevent this from just being a cost of doing business. ie fined 100k for 1 million in fraudlent billing.
     
  3. daveman
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    daveman Diamond Member

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    But we have been repeatedly assured that government-run healthcare will save lots of money.
     
  4. uscitizen
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    uscitizen Senior Member

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    We are also assured that private busineses will regulate themselves.
     
  5. GWV5903
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    GWV5903 Gold Member

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    Our gov is supposed to referee, instead they offer their services for a price, I'll take my chances with the private sector, under this premise I have a choice....
     
  6. daveman
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    daveman Diamond Member

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    The same people who assured me that government-run healthcare will save money also assure me that unless the government keeps a microscope on every facet of every industry, businesses will pollute the air and water until all their customers are dead in order to maximize profits.
     
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  7. Stashman
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    Stashman No Soup For You!

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    It's about time that someone has finally brought this topic up. The finger usually points to fraudulent disability claims by individuals who are drawing a monthly check, but the stats show that is a small number indeed compared fraud by Doctors, hospitals, big pharma, etc...

    An example is how my dad received a power wheel chair through Medicare and it cost $5000.00 dollars. I called the company that makes these chairs and inquired how much it would cost if I walked in with cash and the answer was $1,100. I was in the hospital last yr for hernia surgery, and while looking over the bill I noticed that two Tylenol given to me while there cost me $44.00.

    This is outrageous and needs to stop.
     
  8. SofiaY
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    SofiaY Rookie

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    nice..interesting topic to discuss
     
  9. Greenbeard
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    Greenbeard Gold Member

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    Fraud and abuse are a serious problem. But 1) CMS does go after fraud, and 2) they're currently in the middle of a significant realignment of the way they do so. There was a Congressional Research Service report released a few days ago that details how they go after fraud, as well as what the new ways to go after fraud will look like.

    Namely, they're attempting to transition from pay and chase to fighting fraud before a claim is paid. From that report:

    Part of the way they're doing it is through tools made available in legislation passed last year:

    I also thought this announcement from CMS in June was pretty interesting:

    Again, part of the transition away from pay and chase and toward spotting fraud before CMS pays the claim.
     
  10. The Rabbi
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    The Rabbi Diamond Member

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    IOW they are trying to do this like private insurance companies do. This is why the stat that Medicare is more efficient than private companies is bunk. Private companies spend money weeding out fraud before it happens. Thus their overhead is higher. Medicare allows fraud and then attempts to go after it. Much like closing the barn door after the horse is gone, it isn't effective.

    Yes, we were assured that gov't healthcare would be cheaper and more efficient. If you think it's expensive now, wait until it's free.
     

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