jkapp
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Post by jkapp on Mar 18, 2015 18:32:05 GMT -5
www.msn.com/en-us/money/markets/the-government%e2%80%99s-dollar125-billion-improper-payments-problem/ar-BBilOYd
The Government’s $125 Billion Improper Payments Problem
In 2014 alone, agencies paid a whopping $125 billion in improper or erroneous benefit payments through some of the largest government programs like Medicare, Medicaid and Social Security. That’s the most ever recorded — and a $19 billion increase from the previous year, according to a new report from the Government Accountability Office. For context, the steep defense budget cuts known as sequestration are projected to reduce spending by roughly $100 billion a year from fiscal 2012 through 2021.
The GAO’s tally accounted for erroneous payments across 124 programs under 22 federal agencies. However, just three programs — Medicare, Medicaid and the Earned Income Tax Credit — accounted for more than $80.9 billion of the total.
Auditors blamed these three programs for the uptick in improper payments overall. All three experienced an increased error rate from the year before. Across the government, the errors amounted to 4.5 percent of program outlays, up from 4 percent in fiscal 2013.
Together, Medicare and Medicaid paid out $77.4 billion in improper payments, a 20.4 percent increase over 2013. The programs combined represent about 62 percent of total improper payments government-wide.
---So who is accountable for this? Is anyone losing their jobs over this continued failure? Yeah, good idea democrats! Increase Medicaid enrollees when the program has zero accountability to make proper payments. 
Take note single-payer advocates, this is what you get from that much-touted 3% overhead cost for medicare/medicaid: no one managing the taxpayers' dollars and no one being held accountable for wasteful spending.
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billisonboard
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Post by billisonboard on Mar 18, 2015 18:45:24 GMT -5
How does this compare to private companies?
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Malarky
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Post by Malarky on Mar 18, 2015 19:04:27 GMT -5
How does this compare to private companies? Well, if I make an improper payment-for example accidentally use the company card for personal gas or groceries-my boss notices within 30 days. And I am (rightfully) expected to reimburse the company immediately. Every expenditure is examined and paid within 30 or 60 days, depending terms. Wouldn't it be nice if it were the responsibility of someone in our government to actually verify information before sending out checks? |
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billisonboard
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Post by billisonboard on Mar 18, 2015 19:22:08 GMT -5
How does this compare to private companies? Well, if I make an improper payment-for example accidentally use the company card for personal gas or groceries-my boss notices within 30 days. And I am (rightfully) expected to reimburse the company immediately. Every expenditure is examined and paid within 30 or 60 days, depending terms. Wouldn't it be nice if it were the responsibility of someone in our government to actually verify information before sending out checks? Internal accounting. Totally different. |
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Malarky
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Post by Malarky on Mar 18, 2015 19:31:30 GMT -5
Totally different in that someone is responsible to pay attention.
I realize it's on an enormously larger scale, but there should still be oversight in government.
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djAdvocate
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Post by djAdvocate on Mar 18, 2015 19:33:56 GMT -5
i am not a big fan of the EITC. if we eliminated it, what % of the $125B would be covered?<br>
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djAdvocate
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Post by djAdvocate on Mar 18, 2015 19:34:52 GMT -5
Totally different in that someone is responsible to pay attention. I realize it's on an enormously larger scale, but there should still be oversight in government. i thought this report was produced by those in a position of oversight. silly me. |
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wvugurl26
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Post by wvugurl26 on Mar 18, 2015 19:38:35 GMT -5
Well first of all states pay Medicaid claims. They have the best information to prevent improper payments. The feds have long lacked access to real time Medicaid claims. States submit their expenses quarterly on the 64 report and are paid the federal share that way.
Secondly the same people screaming for oversight would be the same ones screaming if say more stringent point of sale controls were in place and grandma's prescription was rejected by the Part D plan.
I would expect those programs to have the highest rates of improper payments since they spend the most. Medicare spends a trillion dollars per year. Improvements to prevent improper payments are happening daily. All of those are carefully weighed against the potential to interrupt beneficiary access to medical care.
GAO's oversight is limited. If you are looking for oversight go to the Inspector General. I hate blurbs like this that don't also reference how much spending went up.
And finally I believe the improper payment rate is calculated by the external auditors. The best and brightest that big 4 firm is not.
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jkapp
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Post by jkapp on Mar 18, 2015 20:42:10 GMT -5
How does this compare to private companies? If an accounting dept in a private company paid out $125B more than they were supposed to, there would be pink slips a-flyin' 
Heck, if they spent $125,000 more than they should have, there may not be firings (depending on the size of the company) but there would definitely be some stern conversations.
As far as private insurance companies, they are much better at fraud detection and prevention than the feds by far. This website has older data, but it has some interesting stats in it: www.insurancefraud.org/statistics.htm#.VQomcmd0y70
Private health insurance
• Every $2 million invested in fighting health-care fraud returns $17.3 million in recoveries, court-ordered judgments, plus bogus claims that weren't paid and other anti-fraud savings. (National Health Care Anti-Fraud Association, 2008)
• The average health insurer's anti-fraud investigative unit has an annual budget of slightly more than $1.9 million and 19 fulltime employees. (ibid)
• The average health insurer has 363 open cases in 2007, and each insurer investigation unit handled an average of 791 cases total for 2007. (ibid)
• More than seven of 10 insurer investigative units use fraud-detection software. (does the government even utilize anti-fraud software?)
• The U.S. spends more than $2 trillion on healthcare annually. At least three percent of that spending — or $68 billion — is lost to fraud each year. (National Health Care Anti-Fraud Association, 2008)
So about $68B a year in 2008, and this article gives an estimated cost of $60B cost to taxpayers for fraud in 2008:
www.washingtonpost.com/wp-dyn/content/article/2008/06/12/AR2008061203915.html
So that means if total fraud was about $68B and the feds accounted for $60B of that fraud, then all other insurers were hit with the other $8B. So the government accounts for almost 90% of all fraudulent payments. That's just disgusting...no accountability creates this kind of uncaring attitude towards the country's tax dollars, and why I refuse to believe that just increasing taxes will fix our budget problems.
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Deleted
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Post by Deleted on Mar 18, 2015 21:09:13 GMT -5
"Government Efficiency"... if ever there was a combination of words that fit the definition of oxymoron...
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wvugurl26
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Post by wvugurl26 on Mar 18, 2015 21:28:29 GMT -5
First of all that Medicare and Medicaid number does include payments made by private insurers who run Part C and Part D plans and managed care organizations for state Medicaid units. So let's not act like they are perfect. They close more than 363 cases a month. Claims go through a set of pre-pay edits before being approved. It is hampered by laws requiring claims be paid within 30 days.
And probably most importantly, private insurers play by a different set of rules. They don't give a damn if a claim is erroneously denied and John Doe doesn't get his medicine. Medicare and Medicaid are playing with a different rule book. Every edit or change to prevent fraud is weighed against the risk that proper claims will be denied and beneficiaries access to care interrupted. This matters when you insure the most vulnerable populations in the country. And if grandma's prescription is kicked back at the pharmacy, tomorrow morning every Senator is going to be raising hell about why it was denied.
They aren't close to perfect but they are tightening up every year. As I said before it's very misleading to not consider their total payment increase when calculating an increase in improper payments. It isn't the same as private industry. Two different worlds so what works for fraud prevention there won't transfer 100% to government.
On a final note there's a Part D change coming out to limit prescribing to enrolled or validly opted out providers. This requires accounting for different rules in 50 states and DC regarding who can legally write a prescription. The programming cost of this edit alone on the plan side is $100 million + in year one. It's a great change but they aren't free.
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jkapp
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Post by jkapp on Mar 19, 2015 17:58:42 GMT -5
First of all that Medicare and Medicaid number does include payments made by private insurers who run Part C and Part D plans and managed care organizations for state Medicaid units. So let's not act like they are perfect. They close more than 363 cases a month. Claims go through a set of pre-pay edits before being approved. It is hampered by laws requiring claims be paid within 30 days.
And probably most importantly, private insurers play by a different set of rules. They don't give a damn if a claim is erroneously denied and John Doe doesn't get his medicine. Medicare and Medicaid are playing with a different rule book. Every edit or change to prevent fraud is weighed against the risk that proper claims will be denied and beneficiaries access to care interrupted. This matters when you insure the most vulnerable populations in the country. And if grandma's prescription is kicked back at the pharmacy, tomorrow morning every Senator is going to be raising hell about why it was denied.
They aren't close to perfect but they are tightening up every year. As I said before it's very misleading to not consider their total payment increase when calculating an increase in improper payments. It isn't the same as private industry. Two different worlds so what works for fraud prevention there won't transfer 100% to government.
On a final note there's a Part D change coming out to limit prescribing to enrolled or validly opted out providers. This requires accounting for different rules in 50 states and DC regarding who can legally write a prescription. The programming cost of this edit alone on the plan side is $100 million + in year one. It's a great change but they aren't free. A 20% increase in improper payments from 2013 to 2014 is horrendous, never mind not perfect. I'm sure a lot of it has to do with the larger volume of people on Medicaid from the ACA, which is why I again rail on that program for being thrown upon the taxpayer before ANY type of shoring up measures were implemented. This is just bad government, bad policy, and no care whatsoever for the management of the taxpayers' dollars - not to mention another chip away of the taxpayers' trust towards government.
It just goes to show that the governors who did not accept the Medicaid expansion did the RIGHT THING, no matter by what reasons they may have actually refused it.
And if government cannot properly handle fraud prevention, than they shouldn't have gotten into the insurance business in the first place. Just pure irresponsibility...it just sickens me.
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wvugurl26
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Post by wvugurl26 on Mar 19, 2015 18:06:32 GMT -5
First of all that Medicare and Medicaid number does include payments made by private insurers who run Part C and Part D plans and managed care organizations for state Medicaid units. So let's not act like they are perfect. They close more than 363 cases a month. Claims go through a set of pre-pay edits before being approved. It is hampered by laws requiring claims be paid within 30 days.
And probably most importantly, private insurers play by a different set of rules. They don't give a damn if a claim is erroneously denied and John Doe doesn't get his medicine. Medicare and Medicaid are playing with a different rule book. Every edit or change to prevent fraud is weighed against the risk that proper claims will be denied and beneficiaries access to care interrupted. This matters when you insure the most vulnerable populations in the country. And if grandma's prescription is kicked back at the pharmacy, tomorrow morning every Senator is going to be raising hell about why it was denied.
They aren't close to perfect but they are tightening up every year. As I said before it's very misleading to not consider their total payment increase when calculating an increase in improper payments. It isn't the same as private industry. Two different worlds so what works for fraud prevention there won't transfer 100% to government.
On a final note there's a Part D change coming out to limit prescribing to enrolled or validly opted out providers. This requires accounting for different rules in 50 states and DC regarding who can legally write a prescription. The programming cost of this edit alone on the plan side is $100 million + in year one. It's a great change but they aren't free. A 20% increase in improper payments from 2013 to 2014 is horrendous, never mind not perfect. I'm sure a lot of it has to do with the larger volume of people on Medicaid from the ACA, which is why I again rail on that program for being thrown upon the taxpayer before ANY type of shoring up measures were implemented. This is just bad government, bad policy, and no care whatsoever for the management of the taxpayers' dollars - not to mention another chip away of the taxpayers' trust towards government.
It just goes to show that the governors who did not accept the Medicaid expansion did the RIGHT THING, no matter by what reasons they may have actually refused it.
And if government cannot properly handle fraud prevention, than they shouldn't have gotten into the insurance business in the first place. Just pure irresponsibility...it just sickens me.
Okay you must not understand how Medicaid works. The state is in the best position to prevent fraud. CMS does not receive individual claim level data for Medicaid claims. And again how much did spending go up? I'm sure it went up. Even a flat improper payment rate would be expected to go up with an increase in spending. |
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EVT1
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Post by EVT1 on Mar 19, 2015 21:05:09 GMT -5
It just goes to show that the governors who did not accept the Medicaid expansion did the RIGHT THING, no matter by what reasons they may have actually refused it.
Sure- letting your fellow citizens die versus not letting them die because you hate the president is admirable 
The proper move would be to accept the expansion and provide medical care to those who are in dire need of it- also known as the 'RIGHT THING' from a moral standpoint no matter the actual reasons behind such expansion.
It really is that simple. You are either on the side of helping the sick and/or poor or throwing their ass under the bus.
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NoNamePerson
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Post by NoNamePerson on Mar 19, 2015 21:18:27 GMT -5
" Government Efficiency"... if ever there was a combination of words that fit the definition of oxymoron... Hell, I had to google this to see what it meant -rofl-No links came up!! |
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jkapp
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Post by jkapp on Mar 20, 2015 18:24:27 GMT -5
It just goes to show that the governors who did not accept the Medicaid expansion did the RIGHT THING, no matter by what reasons they may have actually refused it.
Sure- letting your fellow citizens die versus not letting them die because you hate the president is admirable
The proper move would be to accept the expansion and provide medical care to those who are in dire need of it- also known as the 'RIGHT THING' from a moral standpoint no matter the actual reasons behind such expansion.
It really is that simple. You are either on the side of helping the sick and/or poor or throwing their ass under the bus.
Which means you're also in favor of government fraud and abuse of taxpayer dollars...it really is that simple. |
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EVT1
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Post by EVT1 on Mar 20, 2015 19:49:12 GMT -5
If the cost of providing health care to all of our citizens who need it is fraud and abuse I am fine with it. We seem to have no problem accepting fraud and abuse when it comes to providing national defense.
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Deleted
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Post by Deleted on Mar 20, 2015 21:02:04 GMT -5
If the cost of providing health care to all of our citizens who need it is fraud and abuse I am fine with it. We seem to have no problem accepting fraud and abuse when it comes to providing national defense. If Obamacare actually DID "provide healthcare to all our citizens"... you might have a point. Problem is, it doesn't do that. It provides a little white card that says you have "Insurance" to all our citizens... in many cases that "Insurance" is completely worthless at helping arrange healthcare. And lets not forget the 30 Million that will "fall through the cracks" (as the saying goes) and still won't have that little white card. |
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EVT1
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Post by EVT1 on Mar 20, 2015 22:51:49 GMT -5
Don't have to tell me- Obamacare is just a marginally better system of shit that we had before.
Wasn't my idea- I support single payer and similar universal systems the rest of the modern world has been using for years.
At the very best- Obamacare moved the USA up a few points from #37 in the world. Still the most expensive in the world and least effective- a fucking joke.
Sad thing is the 'fucking joke' is the best we could do. What does that say about us and our priorities......... |
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jkapp
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Post by jkapp on Mar 21, 2015 7:59:40 GMT -5
Don't have to tell me- Obamacare is just a marginally better system of shit that we had before.
Wasn't my idea- I support single payer and similar universal systems the rest of the modern world has been using for years.
At the very best- Obamacare moved the USA up a few points from #37 in the world. Still the most expensive in the world and least effective- a fucking joke.
Sad thing is the 'fucking joke' is the best we could do. What does that say about us and our priorities......... LOL! And if they waste this many billions on just SOME of the citizens, how much will you allow them to piss away covering everyone?
Its just the total hypocrisy of the left...they went apeshit when $5B of cash was lost in Iraq - yet they don't bat an eye when $84B is lost in Medicare/Medicaid; nearly 17 times that cash that was lost. And Medicare/Medicaid have been losing far more than $5B a year for a hell of a lot longer than we were ever in Iraq. Just total hypocrisy. Its no wonder they hate the Tea Party so much...people who actually want government to be responsible with the taxpayers' dollars? That's just crazy!!
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