Medicare Fraud: A $60 Billion Crime

[VaYank5150]

Medicare Fraud: A $60 Billion Crime - 60 Minutes - CBS News

In fact, Medicare fraud - estimated now to total about $60 billion a year - has become one of, if not the most profitable, crimes in America.

Why has NO ONE, Democrat, Republican or Indepedent passed legislation to tackle this? Should we shut down MediCare?

 

[boedicca]

I seem to recall that one of the ways ObamaCare was justified is that is would get rid of such corruption thus saving $Billions and $Billions.

 

[VaYank5150]

I seem to recall that one of the ways ObamaCare was justified is that is would get rid of such corruption thus saving $Billions and $Billions.

I agree. However, $60 BILLION sounds a bit higher than the rhetoric used to sell the program.

 

[del]

I seem to recall that one of the ways ObamaCare was justified is that is would get rid of such corruption thus saving $Billions and $Billions.

I agree. However, $60 BILLION sounds a bit higher than the rhetoric used to sell the program.

you mean they were less than truthful!?


shocker

 

[Madeline]

Things are so bad, there are reports of Miami-area drug dealers who have gone into Medicaid/Medicare fraud instead. Lower risk, less chance of being caught, few prison terms handed out. The way this fraud usually works is, the criminal buys a list of social security numbers/Medicare numbers and bills the government for goods and services never rendered. Durable Medical Equipment is a perennial favorite, presumably because one does not need any medical credentials to provide these devices.

And that doesn't even begin to deal with the problem of overbilling or furnishing substandard care to patients, (One example of this is abusive dental practices that target Medicaid kids and drill each and every tooth, destroying the kid's mouth, without any need.)

I'm not an expert on fraud prevention at the billing level, but obviously changes need to be made to the enrollment process for providers....much tighter controls need to be in place as to who gets a billing number. Outright fraud, like a "phantom patient list" should bring on a long prison sentence and overbilling should at least result in claw back of the unearned funds.

There are various disincentives to effective investigation and prosecution, as well as punishment. Many in law enforcement are oriented towards drug crimes and cannot see the need to punish a "white collar crime". Others are frankly not trained for these cases, as the methods of proof and so are are vastly different from a drug case. There's a POV that these cases are not "sexy", won't get an investigator or prosecutor anywhere career-wise and take far too long to complete.

IMO, both Medicare and Medicaid need their own investigators and possibly a staff of prosecutors. Some of the criticism about handling an insurance case is fair...it's a different skill set from a violent or drug crime case.

 

[VaYank5150]

Back to my original question. Where has Congress been on this? Can't they enact legislation to MAKE our government oversee this better?

 

[Madeline]

Yes, of course. But from a cost-benefit analysis, it is not desirable to eliminate every dollar of fraud. To do so, you'd have to err on the side of denying claims to such a degree, you'd harm patients. And there are cases where "the candle isn't worth the game". Still, the programs could be MUCH better designed.

Why aren't they?

IMO, the legitimate provider community depends on overbilling to recover "costs" associated with reimbursement rates that are just too low. I believe it is resistance from them that keeps the fraud going.

BTW, one possible solution would be to allow Joe Citizen to sue for fraud against the government. Turn loose a bunch of hungry young lawyers and offer patients rewards for whistle-blowing -- but to do this, you'd need far-reaching changes to HHIPA laws about patient privacy.

 

[DiamondDave]

Congress has been woefully negligent... no doubt... and IMHO, unless there is a complete shakeup of the system, it will continue to be like this

And yes.. I think we should rid ourselves of Medicare and ESPECIALLY Medicaid... and any other government sponsored health care that is not an employment benefit

 

[Madeline]

"Getting rid" of Medicaid and Medicare is not feasible, and doesn't really address the issue: why does Congress allow this level of fraud?

BTW, Medicaid is a state-run program. Congress gives the states about half the necessary funding and the states administer the programs. The investigation and prosecution duties all belong to the states. Medicare is all federal.

 

[DiamondDave]

"Getting rid" of Medicaid and Medicare is not feasible, and doesn't really address the issue: why does Congress allow this level of fraud?

BTW, Medicaid is a state-run program. Congress gives the states about half the necessary funding and the states administer the programs. The investigation and prosecution duties all belong to the states. Medicare is all federal.

Because our overbloated government has become a fraud itself..

And yes... "getting rid" makes little sense... while phasing out makes PERFECT sense

 

[Gadawg73]

First we have to look at the facts.
DOCTORS are the biggest problem, as usual.
Their lobbying for a billto bepassed that ALL submitted bills MUST BE PAID BY MEDICARE within 30 days of filing causes 90% of the fraud.
This has been going on for 50 years. It just got much worse with the 30 day pay bill.

 

[VaYank5150]

First we have to look at the facts.
DOCTORS are the biggest problem, as usual.
Their lobbying for a billto bepassed that ALL submitted bills MUST BE PAID BY MEDICARE within 30 days of filing causes 90% of the fraud.
This has been going on for 50 years. It just got much worse with the 30 day pay bill.

The story points out as much. Now, from what I heard under the Obama administration, that 15-30 day turnaround has been extended to 60 days, but it still sounds like this program is woefully underfunded for fraud investigations and I cannot understand why the Tea Baggers are not all over this one?

 

[Soggy in NOLA]

Medicare has long been the playground for many corrupt healthcare "professionals".

Nothing new here... shut the shit down. Medicaid is far worse off from what I read.

 

[boedicca]

Back to my original question. Where has Congress been on this? Can't they enact legislation to MAKE our government oversee this better?

You are focused on the tree and not seeing the forest.

This is the risk inherent whenever the government redistributes income from those who earn it to others. The bigger the programs get, the bigger the risk of fraud. It's why limited government is healthier for a nation than ginormous complicated programs that nobody fully understands and for which Congress does not read the bill before voting.

 

[Madeline]

I disagree. The problem is not the size of the programs. There is about the same level of fraud at a Medicaid program in any state as at the Medicare/federal level. Any data processing program can be designed with more safeguards against overbilling and fraud, and the cost of doing so is not prohibitive.

I return to my original contention -- it is a give-away to doctors, hospitals, etc. for reimbursement levels that are too low.

 

[boedicca]

B'loney.

Any giveaway by the government entails a Moral Hazard. Fraud happens routinely - it's not a bug, it's a feature.

 

[Madeline]

"Getting rid" of Medicaid and Medicare is not feasible, and doesn't really address the issue: why does Congress allow this level of fraud?

BTW, Medicaid is a state-run program. Congress gives the states about half the necessary funding and the states administer the programs. The investigation and prosecution duties all belong to the states. Medicare is all federal.

Because our overbloated government has become a fraud itself..

And yes... "getting rid" makes little sense... while phasing out makes PERFECT sense

Bad as HHS/state Medicaid is, it is not the worst offender as to fraud. THAT would be DOD...by a wide margin. DOD has declared that it is "unauditable" meaning, no matter what, they cannot account for their expenditures. They are in free fall over there.....it's obscene.

 

[Madeline]

B'loney.

Any giveaway by the government entails a Moral Hazard. Fraud happens routinely - it's not a bug, it's a feature.

All financial reimbursement/disbursement programs are vulnerable to fraud. Private health insurers have a lower rate -- but not by that much.

Ask yourself why you can depend on your bank to keep track of deposits and withdrawals, but your insurance company cannot do it? Answer? Better controls.

 

[johnrocks]

That was a good segment, thanks for sharing! I agree with you too, it is a mess and few seem to care.

 

[johnrocks]

B'loney.

Any giveaway by the government entails a Moral Hazard. Fraud happens routinely - it's not a bug, it's a feature.

All financial reimbursement/disbursement programs are vulnerable to fraud. Private health insurers have a lower rate -- but not by that much.

Ask yourself why you can depend on your bank to keep track of deposits and withdrawals, but your insurance company cannot do it? Answer? Better controls.

How do you know it's better controls? Insurance has been one of the most regulated parts of our society for years.