Medicare/Medicaid Fraud

[golfguru]

It is disgusting that so many people are abusing Medicare and Medicaid and getting away for so long. here is an excerpt from an article I ran into....No wonder Medicare can't pay doctors and hospital a fair amount.

"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......"

[Donnachaidh]

1. link? n/t

[golfguru]

2. Excerpt is from an email I received from a prominent

investment guru named John Mauldin.

[Yavapai]

3. I agree that there is considerable fraud.

In my case, I had a pacemaker/defibrillator implanted about 18 months ago. I was in the hospital at 2:00pm and kept in a room until I was released at 6:00am
the next morning. No complications, nothing special and just a few checks of my vital signs. I didn't even have any food there.

The bill for this was a total of just under $100,000. Medicare caught it and refused to pay for $36,000 dollars that the hospital had charged for me
being in ICU, where I wasn't. I was awake just after the procedure and was taken to the room immediately. Medicare told the hospital that there was never
any need at all for any ICU time and that they should not even attempt to bill me for this.

I wonder just how many of these fraudulent charges do get through and paid.

[golfguru]

4. Thank you for posting actual personal experience...

I guess when money is being paid out by a giant bureaucracy whose workers have no direct incentive to lookout for fraud, it will continue to be abused.

[jwirr]

5. So what are you suggesting be done about it? Why should the poor

and elderly loose their health care because some doctors, etc cheat. Treat it like a criminal case and instead of jail time suspend their license to practice and make them pay the charges back. By the way this happens regardless if the insurance program in government or private.

[golfguru]

6. As a start, drastically increase penalties for Medicare/Medicaid Fraud

Like 20 years mandatory prison for anyone proven to have committed fraud, in a court of law. And I am not talking about occasional errors in billing, but when countless fraudulent claims are submitted. That should put fear in minds of most crooked doctors & hospitals. As for the non-medical person who received $105 million from Medicare by using his laptop, it should be even more severe penalty.

I would also institute simple checks such as number of claims, total amount billed in one year, etc as flags for officials to take over from automated payments and investigate.

Where did you read in my OP that I am advocating cancelling Medicare or Medicaid? What I am really advocating is drastic overhaul of payment practices. There is no excuse for such lax operations simply because it is not the worker's money being lost. This fraud affects all of us, especially me because I am on Medicare. The money wasted on fraud could be much better used to increase compensation for doctors so that 90% of doctors in my town won't refuse to take on Medicare patients.

[jwirr]

7. Ok, as to simple checks - here in MN when I go to the doctor I get

a notice of what they paid for the visit etc. What I am supposed to do with that is look it over and let them know if that did not happen. I have never had a error on one. But my mother had surgery one time and for two years after they were sending these notices and they labeled every single thing that she had - even the aspirins. She looked at it and said, "How am I supposed to know what I got. I don't even remember seeing more than one doctor." She was right - seniors do not always know what is correct on these notices.

[golfguru]

8. The person who was paid $105 million who used a laptop

to bill Medicare, why did they not check if he was a licensed physician/dentist? How many thousands of bills did he submit? $105 million is an inordinate amount of money even by medical standards. You can't tell me it is a difficult thing to pinpoint by a simple software check. I have developed software amounting to millions of lines of codes and I always developed simple checks to segregate simple input errors.

Yes I get the same statements from Medicare you get. From what I have seen, crooked doctors hire paid patients (many times homeless off the street) to participate as patients. So obviously the statements from Medicare are useless in catching the fraud.

[laconicsax]

9. It'd be nice if you included a link or something else for us to verify what's claimed.

[golfguru]

10. How do I link an Email? May be you can try Google to

verify the contents? This information is not classified "Top Secret", so should be easy to verify if you do not trust my source which is email from John Mauldin, a word renowned investment adviser.

I have been reading Mr Mauldin's writings for years and never had a problem with any dishonest claims.

[laconicsax]

11. I don't care much for appeals to authority.

It isn't my job to substantiate claims in your OP. Certainly you trust your source, but why should I? This isn't to say that I think he made it up, but investment advisors aren't infallible and if anything the past three years have shown us, investment professionals aren't paid for their ability to tell the truth.

If you're not willing to support claims made in your OP, I don't know why I should take you seriously.

[golfguru]

12. You absolutely have the right to ignore my post and

ignore what is going on around you. Ignorance is not a
crime!

[laconicsax]

13. I ask for more than just the text of a mass e-mail and you tell me off.

How nice of you.

[golfguru]

14. No offense intended!

But please consider that lot of us read voraciously, and do not make notes of links of each item. Also a link is not necessarily proof that the information is 100% correct. Even major MSM players such as NY Times & WAPO are known to publish erroneous material.

In any case if I had a link I would post it. I would suggest you can do some effort to do more research on this subject and shed more light on it. I would certainly be interested as person on Medicare.