Medicare Fraud

A

Aces_Full

500+ Posts
This is an old article from 60 Minutes (Sept 2010), but the voter ID stuff got me to thinking about gov't run entities for some reason.

The article claims there is 60 Billion dollars of Medicare fraud annually. That is insane. I'm not sure I want our gov't running any programs that large, simply becuase they cannot manage properly or have crooked politians running it.


Medicare Fraud
 
Funny you bring that up Aces. In todays Dallas Morning news is an article reporting on the largest single bust ( to date ) medicaid/ medicare fraud, 425 million, 107 doctors.
One thing i like about a Paul Ryan plan is is created a fraud finding panel.
 
The article points out Medicare's insane policy of paying every claim within 15-30 days. So you can charge literally charge any amount and they will pay it right away. Then just shut down shop and move on to the next location.
 
Imagine if we could eliminate HALF that (which still leaves a ridiculous amount). $30 billion would be a huge boost to our taxpayers.
 
It is amazing to me that anybody who reads an article like the above could ever defend the Republicans and Democrats who created the current system.
 
Medicare was created as part of LBJ's Great Society when the Democrats had a 2-1 advantage in the House and a 2-1 advantage in the Senate as well.

I don't think Republicans had much to do with the creation of Medicare.

Republicans didn't control the House again until 1994 and the Senate in the 1980's.
 
What incentive to government bureaucrats have to eliminate fraud? Their budgets get raised every year without them lifting a finger.

Well, back when we had budgets anyway.
 
First off Byrnes had to do something, what he proposed included lowering of taxes and subsidies, while the Democratic Congress flipped that and instead raised taxes and subsidies, to give Byrnes that much credit is well just not that true. His idea with a way to get there and the Democrats took his idea and got there an entirely different way.

The Prescription Act, as you talk out the side of your mouth. yes it was expensive because of the rising costs of Healthcare and especially Pharmacutical drugs.

In 2004, the 10 cost estimation was $400B, the revised figures in 2006 was $534B and in 2009, that estimate is $550B. On comparison to other government programs that was a pretty good job and it was paid for. It passed the House by 1 vote and was unanimous in the Senate, that sounds bi-partisian to me as the Democrats could have easlity blocked it in the Senate if they wanted too.

Again, Medicare is mostly a Democratic idea that originated under Truman.

Again, what party was in control of the start of Medicare, what happened to it after the fact is not the point.

The Prescription Benefit is one of the
 
BBB
You posted,
"A Republican Congress and Republican President passed the largest expansion of Medicare since its creation with Medicare Part D to cover prescription drugs. "

Amazingly this program has come in UNDER budget every year but the first.
here is a Politifact check link which discusses the 2 ways to estimate it and concludes that no mater which way you choose it does come in under budget
The Link
from link
"Whether it's 40 percent or 28 percent, though, we found wide consensus that the program is coming in under budget."

And the National Economic Bureau of Econmic Research ( a non partisan think tank of mostly Nobel prize wiining economists) put forth a study that found that for every $1.00 spent in part D it saved $2.00 in Medicare. The NBER called it a " salutary effect"
They also pointed out that Part D gave better coverage to poorer seniors.
It makes sense that if a condition can be treated early and with drugs it is cheaper than letting it go until hospitalization is needed.



As to stopping fraud IF Paul Ryans' plan is passed we will start to investigate fraud more aggressively. heck even cutting it in half would be great.
 
Yes, big problem. And of course the instinct of many of you is to use it as a cudgel in your Republican/Democrat warfare.

Let's not pretend, however, that the problem is just that the gubmint caint do nuthin right. Insurance fraud is a huge problem, and the companies spend tens of millions combating it; I'm not sure that a statistical analysis exists concerning whether health insurance carriers or the gubmint do a better job of dealing with this. A quick google indicates that the dollar value of non-medicare insurance fraud is much larger than medicare, but converting speculative numbers related to systems of different sizes and shapes (private health insurance fraud/tort related medical fraud/medicare.medicaid fraud) to data that can be compared across systems to determine relative efficiencies. I'm not sure if that last sentence makes sense, except in my head, but the point is some of you are, with a great jerk of the knee, assuming that the problem is proof of what you already believe. No surprise on the West Mall, I suppose.
 
[quote[but the point is some of you are, with a great jerk of the knee, assuming that the problem is proof of what you already believe.
 
Medicare fraud is a serious problem, and one the Justice Department and Office of Inspector General for HHS vigorously pursue and prosecute. For what its worth, there is a built-in incentive for whistleblowers could can collect anywhere between 5-30% of judgments or settlements under the false claims act. Considering that many settlements are 7-8 figure numbers, this is real money.
Having said that, while actual fraud is no doubt an expensive problem, the biggest driver of cost in my opinion is incentivizing hospitals and physicians to perform more procedures. “Medical Necessity” seems to be more of an art than an objective standard, and Medicare pays for many, many procedures, tests, and treatments that probably do not materially benefit patients. This happens without any fraud.
 
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