Medicare/medicaid: $70 Billion in fraud last year

[ed1066]

The future of Obamacare:

www.cnsnews.com/news/article/medicare-and-medicaid-made-70-billion-im

The Center for Medicare and Medicaid Services—the federal health-care agency that is a key bureaucracy in implementing Obamacare—made at least $70.5 billion in “improper payments” last year.

These improper federal health-care payments amounted to more than the combined total of $68.3 billion spent by the entire Homeland Security and the State departments last year, which spent $44.5 billion and $23.8 billion respectively according to the White House Office of Management and Budget.

Medicare made at least $48 billion in improper payments in fiscal 2010 and Medicaid made $22.5 billion, according to written testimony on "Medicare and Medicaid Fraud, Waste and Abuse" presented to the Senate Subcommittee on Federal Financial Management by Kathleen King, director of health care for the Government Accountability Office.

The full amount of improper payments made by Medicare may be higher than $48 billion because the Center for Medicare and Medicaid Services has not yet estimated the dollar amount of improper payments made by Medicare Part D, the prescription drug-benefit program.

“An improper payment,” said the GAO, “is any payment that should not have been made or that was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements.”

[BeenThere...DoneThat...]

<<< “An improper payment,” said the GAO, “is any payment that should not have been made or that was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements.” >>>

...why don't they just retro-correct the regs so that they redefine improper and may it look, well, proper?

[henryclay]

If the feds really wanted to do so they could stop 99 percent of Medicare/Medicaid fraud in a New York minute.

Jusr issue tamper proof social security, or "for health issues only" ID cards. They have a captive audience who could not refuse. It would.violate no Constitutional or religious tenet, and I keep hearing about these "tamper proof" cards for everything else. Why not try them out for real? Or does the health care inustry have that big a lobby, too?

[Deleted]

If the feds really wanted to do so they could stop 99 percent of Medicare/Medicaid fraud in a New York minute.

Sorry but that statement is based on the assumption that the people that run Medicare are competent. They are not. The federal government doesn't run government well & that's it's business. Anything else they get into is a total screw up. (actually instead of screw up I was thinking about a two word phrase that starts "Cluster ").
That's why I believe that government involvement in most of the additional duties that it performs should be cut back. I believe in LESS GOVERNMENT & LESS GOVERNMENT involvement in businesses.

[ugonow]

More measures have been taken to stop medicare fraud under Obama than any other president. And to say it would be easy for the feds to stop 99 percent of the fraud is a bit of a streach,imo. Does that hold true for insurance companies also? They have a huge fraud problem also. My wife got paid well to investigate cases for one.

[ugonow]

Jusr issue tamper proof social security, or "for health issues only" ID cards.

The biggest frauders in medicare are providers and insurance companies.

[ugonow]

COMPANIES GAVE MORE THAN $5 MILLION TO BUSH/CONSERVATIVES: The 73 health care companies approved to administer the Medicare drug discount card programs gave President Bush and conservatives in Congress a total of more than $5 million in hard money, soft money, and PAC contributions.

TWENTY COMPANIES INVOLVED IN FRAUD APPROVED FOR DRUG CARD PROGRAM: Twenty health care companies approved by the Bush administration to administer the Medicare drug discount cards have been involved in fraud charges, with many being forced to pay fines to federal and local governments because of their behavior.

TWENTY COMPANIES INVOLVED IN FRAUD MADE OVER 60% OF CONTRIBUTIONS: The 20 companies involved in fraud charges represent less than a third of all the approved companies. Yet, they made more than 60% ($3.1 million) of the total campaign contributions from approved drug card companies to President Bush and conservatives in Congress.

[Savoir Faire-Demogague in NJ]

And none of that has anything to do with $70 billion in fraudulent payments.

[ugonow]

Someone was insinuating the fraud was coming from patients.That is not the culprit in the vast majority of cases. The government has not done much to prevent provider fraud in medicare for years. Obama has proposed crackdowns,which there are provisions for in his healthcare bill.

[ugonow]

"Travelers & United Healthcare Settle Medicare Fraud Case or $20.5 Million
Travelers Insurance Co. and United Healthcare Insurance Co. have agreed to pay $20.6 million to settle a civil suit by the U.S. government accusing them of cheating the federal Medicare program which they were supposed to be helping administer. During the investigation, the Government discovered the companies kept two sets of books and lied about their costs." ---There needs to be more than a slap on the wrist in these cases,imo. 20.5 mil is probably just viewed as a part of the game to them.

[AgeOfEnlightenmentSCP]

It's really very simple: STOP ALL DIRECT PAYMENTS TO PHYSICIANS. The money should follow the PATIENT, the patient makes the determination as to how and where to spend their healthcare dollars. It would drive down costs as doctors, hospitals, and other healthcare service providers, and product manufacturers suddenly had to compete for Medicare dollars.

We could even enhance it by providing incentives to economize- patient keeps 50% of anything unspent at the end of the year.

And the best part? We could finally start to phase out the program altogether by replacing it with, at first, fully funded, then supplemented / subsidized Health Savings Accounts.

We simply MUST return to a free market system by slowly getting people accustomed once again to paying for what they consume. That's the ONLY way. There are NO other solutions that work.

[ugonow]

Are you proposing what Paul Ryan is pushing for?A voucher for seniors to buy their own insurance?I doubt companies would be willing to insure them at affordable prices for one thing. If you are just suggesting seniors just pay out of their own pocket,something would have to be done about price structures. Ever notice the difference between what an uninsured person pays and what an insurance company pays for the same treatment code?

[swamp]

Mar 17, 2011 9:07:12 GMT -5 AgeOfEnlightenmentSCP said:

It's really very simple: STOP ALL DIRECT PAYMENTS TO PHYSICIANS. The money should follow the PATIENT, the patient makes the determination as to how and where to spend their healthcare dollars. It would drive down costs as doctors, hospitals, and other healthcare service providers, and product manufacturers suddenly had to compete for Medicare dollars.

We could even enhance it by providing incentives to economize- patient keeps 50% of anything unspent at the end of the year.

And the best part? We could finally start to phase out the program altogether by replacing it with, at first, fully funded, then supplemented / subsidized Health Savings Accounts.

We simply MUST return to a free market system by slowly getting people accustomed once again to paying for what they consume. That's the ONLY way. There are NO other solutions that work.

And all the crackwhores will spend their Medicaid payments on crack, and the grannies with dementia will lose the check, thereby guaranteeing the providers don't get paid.

[henryclay]

There was a time when medical care providers billed the patient and the patient filled out their own insurance claims. All the claim forms were different and were a nightmare, so someone started a cottage industry of filling out insurance claims for the patients, but the patients were still billed by the medical care providers. Then the medical care providers began filing out the insurance claims AND providing the care, too. , , , Which is a BUILT IN license to steal. One of my own doctors was caught in a sting operation padding his services.

As I said above, if the feds really want to stop fraud they can. Whether they ever do it is another question entirely. In conjunction with the tamper proof ID card Palmbeachpaul has the best solution on how to implement the shutdown.

Of course, the cost of care will go up after it is done, too.

[ed1066]

Henry, check your PM

[henryclay]

Thanks, ed.

[BeenThere...DoneThat...]

...can't we just scrap Medicaid now?

[AgeOfEnlightenmentSCP]

Mar 17, 2011 14:26:17 GMT -5 BeenThere...DoneThat... said:

...can't we just scrap Medicaid now?

We don't reign it in, these programs will scrap themselves.