GoldSpider: spiderpaz: I mean, if health care were universal, and every citizen were entitled to it, why would you try to defraud it?

Just making sure :)

I'm sure there's plenty of elective procedures that a universal system wouldn't pay for. Why not get a boob job or tummy tuck if you can get taxpayers to foot the bill?

Lord the two of you are farking clueless. The majority of Medicare Fraud comes in products not services. Companies buy products and charge Medicare without the patients consent or knowledge in most cases. Once people have figured out what went wrong the checks have been cut and the perps are long gone. This happens a lot with nursing homes. Someone gets a patient list and then contacts a distributor with a large order.

chapman: In a government funded system, the incentive is to give care in excess of what is warranted in order to make money/reduce costs/get re-elected.

FTFY.

Lenny_da_Hog: How anti-capitalist of them.

By the way, did you know most big businesses in the US will pay invoices under a certain dollar amount without ever checking if they provided the goods or services for which they're billed?

That's because it costs more money to hunt down fraud than it does just to pay the bill. If the invoice is for $50, and it costs you more than an hour labor to contest it, it's worth paying it without contesting it.

Good, strong, capitalism.



Yeah, and bad debt write-offs are deductible for businesses.

Thrag: Every proper system has a body to fight fraud.

Yeah, like New York does.

They processed 400,000,000 Medicaid claims in 2004 and referred 37 for possible fraud.

(http://www.nytimes.com/2005/07/19/nyregion/19medicaid.html?_r=1)

Money quote:

The responsibility for prosecuting Medicaid fraud lies with the state attorney general, Eliot Spitzer

Looks like he had his priorities elsewhere even then.

Private insurance gets defrauded at a relatively similar rate too. But at any rate the losses due to fraud don't outweigh the cost savings from lower overhead. And Medicare's reimbursement system could be fixed to reduce the possibility of fraud.

Why not at least give people a chance to be in charge of their own destiny.....

Hows about an HSA that is fully tax free, investable, and can be left to your children. Then if you screw that up and there's no money left in it, you have to do the public thing and they can pretty much let you die at 65 like they plan to anyway. But if you use it wisely, chances are by the time you leave it to your kids and they get older, there will be millions in it and they will not need public care of any sort.

DaSwankOne: Flatulent_Flea: Results 1 - 10 of about 73,500 for medicare fraud convictions.

But don't let those pesky facts bother you.

Results 1 - 10 of about 248,000 for insurance fraud convictions. (0.33 seconds)

But don't let those pesky facts bother you.

I have a very hard time accepting this conflation of many webpages with a given phrase with "facts." I hope this isn't a common way of reaching probable truth.

Code_Archeologist: Oh boy... here we go again. Conservatives have used this excuse every time that they have wanted to choke Medicare with a little more with red tape.

The fact is that fraud is no more prevalent (as a ratio of dollars lost from fraud vs dollars paid out) with Medicare than it is with any other private insurance.

...hell, Republicans use this argument any time they don't get their way. "We didn't win in a landslide, ACORN MUST HAVE RIGGED THE ELECTIONS HURR!"

Edsel: Private insurance gets defrauded at a relatively similar rate too. But at any rate the losses due to fraud don't outweigh the cost savings from lower overhead. And Medicare's reimbursement system could be fixed to reduce the possibility of fraud.

It's not really overhead that matters, since the objective isn't "efficiently maximize expenditures". It's health outcomes for the cost (which is why something like, say, Avastin or Nexavar, becomes extremely controversial -- even if it can be dispensed with little overhead; there's a cost-benefit issue).

Incidentally, studies of Medicare have shown that this varies across the country, and the efficiency tends to be worse where there is greater capacity (as in: utilization grows to meet capacity, without significant benefit). This is arguably to be expected given the limited price sensitivity from the point of view of both physician (who may have two financial incentives to overuse -- direct compensation, if it's one of the procedures being compensated at above-cost; and reducing future liability) and patient.

TFerWannaBe: Unscrupulous doctors could also submit claims for treatments they didn't perform or meds they didn't prescribe.

...but then, they can do that now and defraud private companies as well. I don't know what logical fallacy it is when you take a universal concern and paint it as a weakness of a specific policy, but that's a logical fallacy right there.

Gulper Eel: Money quote:

The responsibility for prosecuting Medicaid fraud lies with the state attorney general, Eliot Spitzer

What exactly is wrong with that quote? It's completely true. Prosecuting fraud is indeed the responsibility of the state's law enforcement officials. Private insurance companies also rely on law enforcement to prosecute fraud. If they had said detecting fraud wasn't their responsibility, you'd have point, but they said prosecuting fraud which is entirely the responsibility of the state's legal system.

Polyhazard: DaSwankOne: Flatulent_Flea: Results 1 - 10 of about 73,500 for medicare fraud convictions.

But don't let those pesky facts bother you.

Results 1 - 10 of about 248,000 for insurance fraud convictions. (0.33 seconds)

But don't let those pesky facts bother you.

I have a very hard time accepting this conflation of many webpages with a given phrase with "facts." I hope this isn't a common way of reaching probable truth.

No shiat? You cant' be serious. I thought that was the ultimate way to reach probably truth.

IlGreven: ...but then, they can do that now and defraud private companies as well. I don't know what logical fallacy it is when you take a universal concern and paint it as a weakness of a specific policy, but that's a logical fallacy right there.

They do? Or are you simply assuming they do? As it currently stands, much of private health care is provided through various fixed fee systems. That is , a doctor will be a part of a medical group, which is given a fixed fee per patient. The incentive is to provide care without making unnecessary expenditures. There is utilization review at multiple levels to prevent unnecessary expenditures.

If you switch to a federal system, utilization management will not be as good, because the individual doctors and medical groups will have a smaller incentive to cut costs. (I'd go one step further and argue they'd have an incentive to inflate costs, fully expecting the fed's to not pay them fully. I've seen enough Medi-Cal billing statements to see that when it comes down to it, reimbursement is pennies on the dollar.)

The kicker is that the check on providing too little care is already in existence, people can sue their doctors if they fail to meet the standard of care due to financial incentives. There is no similar check for providing too much care. Unless, of course, we come to the point of healthcare rationing (which I don't think will be the case.)

Code_Archeologist: Oh boy... here we go again. Conservatives have used this excuse every time that they have wanted to choke Medicare with a little more with red tape.

The fact is that fraud is no more prevalent (as a ratio of dollars lost from fraud vs dollars paid out) with Medicare than it is with any other private insurance.

Would be easy to fix too. Start revoking medical licenses nationally and you'd see individual doctors stop. Start seizing personal assets and you see smaller clinics stop. Start treating it like RICO does and you'd see corporations stop. You want to scare a rich person, tell them that if they do X they will be poor. Toss in barring any of them from working in said profession / field again (or holding any corporate board / officer position) and you'd scare 95% at least.

private businesses of all types have lied, cheated and stolen.

I'm sure the WSJ will be denouncing them next.

We should deny some 50 million people of insurance because somebody might try to take advantage of it. Got it.

EL_FABREZ: We should deny some 50 million people of insurance because somebody might try to take advantage of it. Got it.

Let's hope they don't look into Military fraud....

So if a government program has a fraud problem, that must mean all government programs will have fraud problems, so we shouldn't leave any of these things to government programs.

Can we extend that logic to the private sector? Since the Enron and WorldCom scams clearly indicate that private industry is ripe for and rife with fraud and corruption, nothing should be left in the hands of private industry. The Enron debacle clearly indicates we should dismantle all private power companies.

Why would the Republican God allow this to happen?

Isn't the GOP under the direct watchful eye of God? Why would he allow Satan to take over America with such obvious fraud!?

Why does everyone always compare this to medicare? What about Tricare? Tricare is farking fantastic.

Lenny_da_Hog: Why would the Republican God allow this to happen?

Isn't the GOP under the direct watchful eye of God? Why would he allow Satan to take over America with such obvious fraud!?

There is a guy from my high school that posted this on facebook the other day:

All that constrains nations from destroying themselves by their selfish pursuit is the constraining hand of God. Here lately it feels like God is letting go of the constraint as we run faster and faster towards the cliff so that we will hit the bottom and turn back to Him. There is much repentance in order for America to turn back to God. How desperate we are to be saved from ourselves. Bring Revival!

Republican God is allowing us to drive off the cliff because he loves us.

inglixthemad: Would be easy to fix too. Start revoking medical licenses nationally and you'd see individual doctors stop. Start seizing personal assets and you see smaller clinics stop. Start treating it like RICO does and you'd see corporations stop. You want to scare a rich person, tell them that if they do X they will be poor. Toss in barring any of them from working in said profession / field again (or holding any corporate board / officer position) and you'd scare 95% at least.

You act as if the Medical Board already doesn't revoke or suspend licenses for improper conduct. But if you mean that there should be a new form of enforcement, there are plenty already in the form of civil suits, criminal complaints and medical board actions. If you think the medical profession is interested in one more source of threat to their livelihood, you are mistaken. That "95%" of Doctors you just mentioned? Many will simply opt for different careers.

Thrag: What exactly is wrong with that quote? It's completely true.

It's also completely true that Spitzer was more interested in his crusades against The Man^TM than he was in boring old Medicaid fraud. There's not as much publicity to be reaped, nor as many votes to be gained, by chasing hundreds of anonymous douchebags gaming the system as there are by focusing on individual Wall Street asshats.

Thrag: So if a government program has a fraud problem, that must mean all government programs will have fraud problems, so we shouldn't leave any of these things to government programs.

No. It applies to government programs that are big enough to be able to distort the market. This is why the sharpies rip off Medicaid and the Pentagon, and not the National Science Foundation. At some point it becomes more lucrative for a business to suckle off the government teat than it does to hustle after private-sector business - and a $70b program like New York Medicaid most certainly falls into the category of "big fat juicy pigeon ripe for the plucking".

Just out of curiosity, how would one defraud someone out of something that would be offered for free anyway?

Incentivize savings. Until you or I or whomever benefits from shopping around and saving, or from living healthier, costs will continue to rise. We need more Doctors. Whats wrong with increased competition (across state lines) amongst insurance companies?

Not just that, but Medicare coverage SUUUUUUUUUUUUUUUCKS. You don't go on Medicare if you have an option of another insurance. My best friend is struggling with her insurance company right now as she needs an expensive drug to help with her advancing rheumatoid arthritis.

Her insurance company is fighting her on it, but with Medicare this class of drugs is simply and completely out of the question. I investigated the possibility of getting her on Medicare, and as it turns out Medicare has a cap on how expensive the drugs are that they will consider paying for.... anything more expensive than that cap and you can go fark no matter how bad you need it. At least with the insurance company it's a possibility...

She's have to be out of her mind to switch to Medicare from her private insurance... and her insurance aint all that great.

I just want my sick friend to hurt less. :(

Thorndyke Barnhard: Just out of curiosity, how would one defraud someone out of something that would be offered for free anyway?

Problem: Cut finger.

Bill for:
Band-Aid
heart-lung machine reimbursement
Run sonogram of internal organs
Run EEG
Run echo cardiogram
Test for sickle-cell on non-African-heritage patient.

etc.

L82DPRT: We need more Doctors. Whats wrong with increased competition (across state lines) amongst insurance companies?

We have more doctors per capita now than we have had at anytime in history. This is just another lie pushed by the conservatives.

GoldSpider: This is from the WSJ, so all facts presented in the article are to be dismissed without consideration or discussion.

It's also time for Two Minutes of Faux News Hate.

The strange thing is that even though Medicare is relatively easy to defraud, it is still very efficient, and my mom's neighbors are getting amazing coverage at a prestigious hospital in Chicago.

This year, outlays are $501 billion split among 43 million participants, or about $11,700 per beneficiary. Costs are high because Medicare endures the patient pool from Hell. The first and healthiest circle of this pool, the Righteous Pagans if you will, are the 36 million Americans over age 65. Of the other seven million remaining, the second circle is dominated by the healthiest are disabled enough to have received Social Security disability for two years. In the third circle are people with Lou Gehrig's disease who are eligible for SSDI; if you're healthy enough to work in an office you're too healthy to qualify and must wait for the disease to progress. In the fourth circle are people with end-stage renal disease on dialysis and people needing kidney transplants.

Meanwhile a comparable policy from Blue Cross costs about $450/month for a single man chosen at random from Americans aged 18 to 64. I'm currently somewhat insulated by being in a student pool dominated by 25-year-old grad students; to continue would cost $430/month and they are demonstrably worse than Blue Cross or Medicare.

Yeah. Shout louder, and maybe we won't hear the sound of UHC working in just about every other country worth living in on planet Earth.

Notice how the article fails to make ANY mention of the proven rate of fraud compared to private insurance plans?

Yeah, that's how the Wall Street Journal deliberately lies by omission on a daily basis.

Lenny_da_Hog: Run sonogram of internal organs
Run EEG
Run echo cardiogram

Maybe not - CMS today proposed eliminating the "in-office Stark exemption" that allows doctors to provide these sorts of tests in their office.

Echo is among those that would still be allowed, but at a 42% reimbursement cut. That is a government headfake that effectively eliminates that too; because, unless you are a high volume urban practice, a 42% reimbursement cut will put you below labor costs, let alone pay for equipment, supplies, etc.

Welcome to government healthcare.

Hey, wait a minute...

I'm a pharmacy technician. I deal with insurance hundreds of times per day. It's loads easier to defraud the private insurance companies, I know. Medicare has so many limits that it actually makes me have to think about submitting a claim. With the private insurers, only the most ludicrous claims are rejected. Medicare rejects a claim if I get something as simple as calculating the "days supply" wrong, even when it comes to things like creams and ointments, where I barely have enough information to calculate that supply. Coming from someone who knows what he's talking about, Medicare IS NOT easy to defraud.