Waste, corruption and inefficiency. This fraud-riddled system is the model on which the socialists would base universal health care. To put $47 billion of taxes in perspective: the proposed 2010 NASA budget is $18.7 billion. http://www.chron.com/disp/story.mpl/ap/business/6721493.html By HOPE YEN Associated Press Writer WASHINGTON — The government paid more than $47 billion in questionable Medicare claims including medical treatment showing little relation to a patient’s condition, wasting taxpayer dollars at a rate nearly three times the previous year. Excerpts of a new federal report, obtained by The Associated Press, show a dramatic increase in improper payments in the $440 billion Medicare program that has been cited by government auditors as a high risk for fraud and waste for 20 years. It’s not clear whether Medicare fraud is actually worsening. Much of the increase in the last year is attributed to a change in the Health and Human Services Department’s methodology that imposes stricter documentation requirements and includes more improper payments — part of a data-collection effort being ordered government-wide by President Barack Obama next week to promote “honest budgeting” and accurate statistics. Still, the fiscal 2009 financial report — covering the first few months of the Obama administration — highlights the challenges ahead for a government that is seeking in part to pay for its proposed health care overhaul by cracking down on Medicare fraud. While noting that several new anti-fraud efforts were beginning, the government report makes clear that “aggressive actions” to date aimed at reducing improper payments had yielded little improvement. In recent years, the suspect claims have included Medicare prescriptions from doctors who were dead, and requests for payment for medical supplies such as blood glucose strips for sexual impotence and diabetic shoes for leg amputees. Patients, many of them new citizens who barely speak English, are sometimes recruited by brokers who go door-to-door offering hundreds of dollars for use of their Medicare numbers. Obama is expected to announce new initiatives next week to help crack down on Medicare fraud, including a government-wide Web site aimed at providing a fuller account of health care spending and improper payments made by various agencies. The Centers for Medicare and Medicaid Services also will launch a Web interactive next month that will allow users to track Medicare payment information by categories such as state, diagnosis and hospital. According to the report, the Bush administration from 2005-2008 reported improper payments of roughly 4 percent in the fee for service program, or about $17 billion total in 2008. Government officials at the time, however, typically did not consider a Medicare payment improper if the medical documentation was incomplete or a doctor’s signature was illegible. Since these were flaws that ordinarily bar payment, that methodology drew complaints from government auditors that the figures were understated. For fiscal year 2009, the Obama administration began counting those claims as improper, but was unable to complete an official tally based on the new methodology. As a result, it officially reported improper payments for its fee for service program at 7.8 percent, representing a partial tally under the new formula. But it considers the unofficial tally of 12.4 percent to be more representative. Beginning next year, the 12.4 percent figure — or a total of $47 billion in improper payments when counting both Medicare fee for service and managed care — will be used as the baseline estimate. The federal report sets a target of reducing improper payments in the fee for service program to 9.5 percent by next year, which would represent a savings of roughly $9.7 billion. The findings come as the Obama administration is making Medicare anti-fraud efforts an important priority. In recent months, HHS has said it was multiplying by 10 the number of agents and prosecutors targeting fraud in Miami, Los Angeles and other strategic cities where tens of billions of dollars are believed to be lost each year. The new partnership seeks to have better sharing of real-time intelligence data on health care fraud patterns. Officials say they also want to increase training and outreach among Medicare providers to reduce documentation errors, while proposed health overhaul legislation would increase background checks on Medicare claimants and impose stiffer penalties for false claims. Other findings: —In the Medicaid program for the poor, roughly $18.1 billion, or 9.6 percent of claims, are believed to be improper payments. —Using a baseline of 12.4 percent in improper payments in the Medicare fee for service program, HHS is setting targets of reducing fraud and waste to 9.5 percent, 8.5 percent, and 8.0 percent, respectively, for fiscal years 2010 through 2012. Records released earlier this week showed that CMS for three years ignored internal watchdog warnings about swindlers stealing millions of dollars by scamming several Medicare programs. The agency received roughly 30 warnings from inspectors but didn’t respond to half of them, even after repeated letters. ——— On the Net: Government anti-fraud page: http://www.stopmedicarefraud.gov/
If we're playing with the highest figures, to put 44,800 deaths into perspective, that's roughly 10 or 15 times more deaths per year more then have been caused by ALL domestic terrorist attacks on American soil (Islamic or right-wing extremists). I think that's what socialists and communists like myself are basing their concerns on.
This is why the government should force the healthcare industry - all aspects of it - to reduce costs.
You gotta love Republican hypocrisy, they hate regulation on business but also hate fraud in government programs. It seems because of the former being lax the latter is running wild.
So because there are waste and fraud we should not have medicare or medicaid. We should not have a national defense system because it is also full of waste and fraud. We should not have a national transportation system. We are all better off if there were no nations on earth and everything is run by the corporate entities. Yes that would be so great, as the current financial melt down demonstrated that the corporate entities are always responsible citizens.
OK. I see your point. From this though springs forth a few honest questions: 1. How many fraudulent claims were paid by private insurance companies? It takes a doctor to be complicit in the fraud and the coding process works similarly. 2. How many meritorious claims were denied wrongly by private insurance companies? This happens more than anybody would like to talk about. 3. What is the answer? A more intense, labor intensive and expensive review system? Scrap the whole thing? Let those who cannot afford Cadillac coverage go without? The bottom line is that ANY system (public or private) will have significant opportunities for fraud. Should we devise reasonable ways to lessen the fraud? YES. Should we use the existence of external fraud as an excuse to scrap programs that people depend on? No. With the standard of living in this country today, to have a health care system that fails to address the needs of so many is a farce. I am very glad that you have never found yourself in need without the means to obtain. I have seen enough people in my law practice that were not as fortunate. Believe me when I tell you that you should take an attitude more of "there but for the grace of God go I."
Something to note is that you have exploiters in all aspects of life. You have to ask if the overall is better than what happens to the very small percentage of said exploiters. So while sure, you have these fraudulent claims, how many claims were legit and provided folks with proper healthcare measures. Sadly some more vocal republicans have a habit of accentuating these exploiters as a reason to pull something back. All it does is muddy the issue of the overall good.
Those wasteful costs suck. That's why I'm glad that a portion of the new health care system will be paid for by cutting the waste out of medicare.
I was trying to find some statistics on private health insurance fraud, and there really are no statistics. I guess one can say that the gov't has done a better job of trying to hunt down fraud in its system. But the more relevant point is that fraud is a concern in just more than gov't healthcare run programs
