Stop The Welfare State, Vol III: How Medicare Abuse Is Taking You To The Cleaners.
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01-07-2013, 10:59 PM
Stop The Welfare State, Vol III: How Medicare Abuse Is Taking You To The Cleaners.
http://www.forbes.com/sites/merrillmatth...illions/2/

From Forbes.com

When President Obama pushed through his health care bill, he cut more than $500 billion (over 10 years) in future Medicare spending in order to claim the bill was “paid for.” A better option would have been to aggressively target Medicare and Medicaid fraud, which could have provided the same amount of savings, and possibly more.

Barely a day goes by without a major news story highlighting some new Medicare or Medicaid scam that has bilked the government — that is, taxpayers — out of millions of dollars.

Though most of the reports involve only a few people and scamming under $10 million, that’s chump change when compared to some of the bigger busts.

For example, federal authorities announced on May 2 they had arrested 107 health care providers, including doctors and nurses, in several cities and charged them with cheating Medicare out of $452 million.

To put this in perspective, the collapse of the solar company Solyndra, which had taken $535 million in taxpayer dollars from the Obama administration, has been a recurring topic in the media and public debates. The Medicare fraud arrest mentioned above was a news story for only a day or two.

Or there was the 2010 story in which federal officials charged 94 people with $251 million in phony claims.

The problem isn’t new. Federal officials set up the Medicare Fraud Strike Force in 2007, which visited at random nearly 1,600 businesses in Miami, ground zero for Medicare fraud, that had billed Medicare for durable medical equipment. Officials found that nearly a third of the businesses, 481, didn’t even exist, yet they had billed Medicare for $237 million over the previous year, according to National Public Radio.

Indeed, scamming Medicare and Medicaid is so lucrative that the Russian and Nigerian mobs have gotten involved. And one of the New York crime families has moved to Florida because defrauding Medicare is both more lucrative and less dangerous than some of the traditional organized crime activities.

And Medicaid is just as bad, or worse. New York City has been a huge problem for Medicaid with one former official suggesting that 40 percent of NYC’s Medicaid payments are “questionable. ” The New York Times, in a multi-story expose several years ago, reported that a Brooklyn dentist had filed 991 claims in one day.

And while every state struggles with Medicaid fraud, the Office of Inspector General says the five topping the list are California, Texas, New York, Ohio and Kentucky. The good news is that states recovered $1.7 billion in fraudulent payments in 2011. The bad news is the government had to spend $208 million to do it.

Federal authorities boast of recovering $4.1 billion in 2011 from fraudulent activity, but again spent millions of dollars to recover it.

How much Medicare and Medicaid fraud is there? No one knows for sure. In 2010 the Government Accountability Office (GAO) released a report claiming to have identified $48 billion in what it termed as “improper payments.” That’s nearly 10 percent of the $500 billion in outlays for that year. However, others, including U.S. Attorney General Eric Holder, suggest that there is an estimated $60 to $90 billion in fraud in Medicare and a similar amount for Medicaid. Big money!

Ironically, ObamaCare cutting $500 billion, as I have pointed out elsewhere, was an accounting sham. However, there is so much Medicare and Medicaid fraud that Democrats could have covered much of the cost of ObamaCare without the accounting tricks, had they really gone after it.

To be fair, the Obama administration is trying. ObamaCare allows the Department of Health and Human Services (HHS) to step away from its “pay and chase” model — where Medicare and Medicaid routinely paid every bill that comes in and only goes after someone if it’s blatantly obvious that something was wrong … like 991 dental procedures in one day.

HHS is beginning to embrace what private sector health insurers have done for years: pre-claims adjudication. As HHS Secretary Kathleen Sebelius stated, “Now, we’re analyzing patterns and trends and claims data, instead of just going claim by claim,” according to MSNBC news. That is certainly a step in the right direction, but it doesn’t go far enough, nor fast enough.

There are no good numbers on how much money private sector health insurers lose in fraud, but working with a well-known health care actuary a few years ago, we estimated that private insurers lose perhaps 1 to 1.5 percent in fraud. Medicare and Medicaid may be closer to 10 to 15 percent. And one of the primary differences is that the private sector insurers embrace software and other new technologies that help them find discrepancies and fraud in health care claims.

It’s true that politicians routinely claim they are going to get the fraud and waste out of government programs, and almost never do. The difference here is that HHS’s pay and chase model has been an open invitation to fraud — and criminals gladly accepted it.

Catching the scammers after the fact is too late; most of the money is already gone. The government needs to process claims in a way that identifies questionable and improper claims before they are paid. If the Obama administration really wants to lower health care spending, Medicare and Medicaid fraud is a good place to start.


Up next on Stop the Welfare State, Vol IV: How we can save some serious green by getting rid of the Green Mile.

"IN THRUST WE TRUST"

"We were conservative Jews and that meant we obeyed God's Commandments until His rules became a royal pain in the ass."

- Joel Chastnoff, The 188th Crybaby Brigade
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29-07-2013, 11:05 PM
RE: Stop The Welfare State, Vol III: How Medicare Abuse Is Taking You To The Cleaners.
http://www.cnn.com/2013/07/29/health/reh...?hpt=hp_t1

Yet another example of flagrant MediCare abuse billed to the taxpayer.

"IN THRUST WE TRUST"

"We were conservative Jews and that meant we obeyed God's Commandments until His rules became a royal pain in the ass."

- Joel Chastnoff, The 188th Crybaby Brigade
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29-07-2013, 11:09 PM
RE: Stop The Welfare State, Vol III: How Medicare Abuse Is Taking You To The Cleaners.
My husband can write a book on this subject.


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30-07-2013, 09:24 AM
RE: Stop The Welfare State, Vol. V
I would rather pay claims to scammers than not paying claims for truly sick people.

We all know, and I mean all, people who have been tweaked around by their health insurance for various reasons. A simple example, my daughter-in-law recently spent some 8 days in the hospital, her insurance says 2 of those days were unnecessary and will not be covered. What kind of bullshit is that.

There are scammers everywhere. Health care in total is a huge scam if you look at actual costs vs. charges. We as a collective should line up doctors and hospital and insurance administrators and off 1/3 (after we do the same with lawyers and judges). Then say ok now how do we deal with responsible health care for all.

Scams are inherent in any human activity that involves large amounts of money. The biggest scam in health care in the US is its cost.

That the government pays for not needed stuff is important. More important is insurance companies not paying for needed medical procedures.
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30-07-2013, 11:59 AM
RE: Stop The Welfare State
The title begins by conflating 'welfare' with 'fraud.' Classic.

Quote:Federal authorities boast of recovering $4.1 billion in 2011 from fraudulent activity, but again spent millions of dollars to recover it.

I'm familiar with the $4.1 billion stat. It has nothing to do with medicare, and "recovering" isn't accurate. They just didn't pay out some of the most egregious fraudulent tax refunds. And the millions they spent were the wages of the employees that they'd be paying anyway.

I don't know much about Medicare, but catching misrepresentations like this makes me doubt the rest of the article.

If any administration wants to reduce health care costs, allowing Medicare and Medicaid to negotiate lower bulk-purchase drug prices would be a great place to start. That would cut the dollars on every bill before they were charged, and make fraud less lucrative, instead of stopping payment on some fraction of 10%-20% of total payments.

Quote:The government needs to process claims in a way that identifies questionable and improper claims before they are paid.

Yes, of course. The overloaded bureaucracy should be funded and staffed in such a way to allow them to do it, too. You'd get similar results as other instances of spending millions to save billions. First, reinstate the scheduled pay raises federal employees have been denied so as to slow attrition, then stop using under-incentivized temp employees, then lift the federal hiring freeze and hire some real public servants.

Oh, wait, did the writer mean to be advocating more big government?

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30-07-2013, 12:16 PM
RE: Stop The Welfare State, Vol III: How Medicare Abuse Is Taking You To The Cleaners.
(29-07-2013 11:05 PM)Carlo_The_Bugsmasher_Driver Wrote:  http://www.cnn.com/2013/07/29/health/reh...?hpt=hp_t1

Yet another example of flagrant MediCare abuse billed to the taxpayer.

This is the subject on Anderson Cooper tonight.

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Those who were seen dancing were thought to be insane by those who could not hear the music - Friedrich Nietzsche
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30-07-2013, 12:27 PM
RE: Stop The Welfare State, Vol III: How Medicare Abuse Is Taking You To The Cleaners.
It's not just scammers. It's also hospitals that refuse to abide by Medicare rules. They order exams that Medicare simply won't pay for. Then they go back and add things to make the exam appear "needed".


God is a concept by which we measure our pain -- John Lennon

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30-07-2013, 01:25 PM
RE: Stop The Welfare State, Vol III: How Medicare Abuse Is Taking You To The Cleaners.
(30-07-2013 12:27 PM)Momsurroundedbyboys Wrote:  It's not just scammers. It's also hospitals that refuse to abide by Medicare rules. They order exams that Medicare simply won't pay for. Then they go back and add things to make the exam appear "needed".

There is also a law called the Hill-Burton Act. Hospitals are required to have a segregated fund to pay for ER care for people who cannot afford it. What that actually do, is just use their Hill-Buron funds to cover the first "x" amount of any loss $ from their fiscal year, without regard to how the loss was incurred. Totally NOT in the spirit of the law. They just get away with it.

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Those who were seen dancing were thought to be insane by those who could not hear the music - Friedrich Nietzsche
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03-08-2013, 02:49 AM
RE: Stop The Welfare State, Vol III: How Medicare Abuse Is Taking You To The Cleaners.
Resistance to socialism, oh you silly kids you...

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