Medicare Fraud: A $60 Billion Crime

Discussion in 'Politics' started by VaYank5150, Sep 7, 2010.

  1. VaYank5150
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    VaYank5150 Gold Member

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

    Why has NO ONE, Democrat, Republican or Indepedent passed legislation to tackle this? Should we shut down MediCare?
     
  2. boedicca
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    boedicca Uppity Water Nymph Supporting Member

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    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.
     
  3. VaYank5150
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    VaYank5150 Gold Member

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

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    you mean they were less than truthful!?
    :eek:

    shocker
     
  5. Madeline
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    Madeline BANNED

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    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.

     
  6. VaYank5150
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    VaYank5150 Gold Member

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

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    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.
     
  8. DiamondDave
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    DiamondDave Army Vet

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    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
     
  9. Madeline
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    "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.
     
  10. DiamondDave
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    Because our overbloated government has become a fraud itself..

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

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