Medicare fraud's alive and well

[Tallison]

much of which takes the subtle and insidious form of lenient treatment decisions for Medicare-covered patients that self-pay patients or those covered by companies that can afford hawk-eye case managers would never merit. And don't think this translates into high-quality care for its recipients. How does a 91 year-old presenting to the ER with dehydration and arrhythmias benefit from a full-scale cardiac, GI, and renal work up? Upshot is that 1) In 15 years its budget will be kaput; 2) The availability of resources for Medicaid subsidization suffers as an indirect result.

Folks, just be aware of how ability to pay does affect treatment decisions in this country and how this adversely affects not just the indigent but those who will supposedly be Medicare-eligible in the future.

[SharonAnn]

1. Yes, check TennCare in Tennessee for how it's worked out since

Bonneyman sued and won for just about everyone to be treated for just about anything with just about any drug or medical procedure. he refused to negotiate with our governor on, for example, generic drugs or a limit of the nubmer of prescriptions or a sliding co-pay for people who were not needy but couldn't get any other insurance.

No ability to limit things meant it was bankrupting the state, so the only alternative was removing anyone but children and the very needy from Tenncare.

[Tallison]

2. And it's only going to get worse

Sometimes I think Medicare's tumescent budget is just an excuse to axe Medicaid. You know that in VA if a provider doesn't file a Medicaid claim within one business day of treatment, the claim is automatically denied by Medicaid case managers with no appeal process? So who pays? The treatment facility and the physician, who next time are a lot more cautious about accepting Medicaid referrals. No such thing as case managers that work specifically for Medicare.

I swear this economy is doomed.

[Lydia Leftcoast]

3. Actually, my brother the doctor is upset with Medicare for a totally

different reason.

He says that the anti-fraud regulations are so complex and detailed that it's possible to violate them accidentally.

[Tallison]

4. Which is one of the reasons

the Justice Department so rarely prosecutes anyone except in the most egregious, obvious instances. Unfortunately the regulations' complexity provides a specious excuse for a lot of nefarious activity.