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(Washington Post)   Awesome new $77m computer system aimed at stopping $60 billion in annual Medicare fraud has caught exactly one suspicious payment, saving us taxpayers the fabulous sum of $7,591   (washingtonpost.com) divider line 107
    More: Fail, Medicare fraud, medicare, Tom Carper, payments, taxpayers  
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2449 clicks; posted to Politics » on 24 Feb 2012 at 5:57 AM (2 years ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2012-02-24 09:01:15 AM
The government needs to keep its hands off my Medicare!
 
2012-02-24 09:01:15 AM

jayhawk88: Gulper Eel: jayhawk88: Well, that $7,591 figure is going to be a fun little chestnut to hear about approximately 9 billion times from whomever ends up "winning" the GOP nomination. Christ they're probably printing it up on t-shirts as we speak.

I doubt it.

Medicare is some serious bluehair vote-buying money.

"President Obama said he would reform Medicare *background picture of a worried looking senior*, but let's look at what actually happened. They gave $77 million to Silicon Valley *picture of laughing geek* for a computer that would detect Medicare fraud, and it did: $7,591 worth of fraud *pic of someone in a hospital bed*. That's $77 million that could have been better spent helping those in need *pic of someone on a respirator*, rather than just lining the pockets of Obama's Silicon Valley cronies *two CEO's laughing*.

Mitt Romney understands the needs of Medicare recipients *pic of someone helping someone in a wheelchair*, and will eliminate wasteful Medicare spending, in real ways that make sense. Vote for common sense, vote for Romney."


I heard it costs $200 million/day just to run this thing.
 
2012-02-24 09:03:44 AM

bravian: FTFA "My point is there was off-the-shelf stuff they could have bought and applied," said Coburn. "You don't have to recreate the wheel."

The article is full of fail. But this especially grates me. For stuff like this you can't go to Best Buy and buy it. It has to be built. Now there are inefficient and efficient ways to build it but either way its going to cost a large chunk of money when you deal with these volumes.

/I call bullshiat on the 60 billion number - that assumes that 16% of all claims are fraud (assuming you believe the $1 billion a day in claims which I don't). That is much much higher than we know it to actually be
//works for a health insurance company


I was thinking that too - off-the-shelf fraud detection software for Medicare? I work at a company that sells (among other things) fraud detection software for insurance companies. Coburn has absolutely no idea what he's talking about.

I wish we had bid; we could have delivered better and cheaper :)
 
2012-02-24 09:10:49 AM
There seem to be some people in this thread who know what they're talking about.

I've been wondering - considering how much we spend a year on Medicare/Medicaid, would it not be cheaper for the government to set up a nationwide network of free clinics and hospitals, rather than serving as a de facto insurance company for the elderly and disabled? The competition might even drive down healthcare costs.
 
2012-02-24 09:12:22 AM

FlashHarry: [rickscott image 620x465]

what medicare fraud may look like.


Shiat, you could put any Florida politician in there and it would hold true. If anybody ever solved Medicare fraud in Florida, the state's economy south of Disney World would collapse.

/exaggerating
//only a little
 
2012-02-24 09:13:55 AM

tgregory: If a company did this to you all you'd be outraged. At least when a company farks up it's with money they've raised on their own and at their own risk. (Unless you're one of those idiots who voted for the bailouts.)


I've worked on a couple of multi-million dollar IT failures. The consultants were still paid their millions and the executives were able to either spin them as a great success, or quietly cancel them due to "changing business priorities" and collect their bonuses. The cost is written off so in a sense, the taxpayer still subsidizes the waste.
 
2012-02-24 09:14:31 AM

imontheinternet: There seem to be some people in this thread who know what they're talking about.

I've been wondering - considering how much we spend a year on Medicare/Medicaid, would it not be cheaper for the government to set up a nationwide network of free clinics and hospitals, rather than serving as a de facto insurance company for the elderly and disabled? The competition might even drive down healthcare costs.


ZOMG SOCIALISMS!11!!
 
2012-02-24 09:15:19 AM
Imagine if they turned that computer loose on Wallstreet. It would be gouting smoke in the first 10 seconds.
 
2012-02-24 09:15:39 AM

Gig103: [images.zap2it.com image 260x360]

The government has a system for trying to detect Medicare fraud, but it sucks. I know, because I created it.


Person of Interest is a fantastic show!
 
2012-02-24 09:16:12 AM

imontheinternet: There seem to be some people in this thread who know what they're talking about.

I've been wondering - considering how much we spend a year on Medicare/Medicaid, would it not be cheaper for the government to set up a nationwide network of free clinics and hospitals, rather than serving as a de facto insurance company for the elderly and disabled? The competition might even drive down healthcare costs.


I suppose we could do that, but we could also fark Jesus' skull with Stalin's zombie dick, you filthy socialist.
 
2012-02-24 09:17:48 AM

Eddie Adams from Torrance: tgregory: If a company did this to you all you'd be outraged. At least when a company farks up it's with money they've raised on their own and at their own risk. (Unless you're one of those idiots who voted for the bailouts.)

I've worked on a couple of multi-million dollar IT failures. The consultants were still paid their millions and the executives were able to either spin them as a great success, or quietly cancel them due to "changing business priorities" and collect their bonuses. The cost is written off so in a sense, the taxpayer still subsidizes the waste.


I think we work for the same company.
 
2012-02-24 09:18:46 AM
Maybe it went to the black budget to fund Area 51. I want to believe the government doesn't waste money.
 
2012-02-24 09:23:58 AM

bravian: FTFA "My point is there was off-the-shelf stuff they could have bought and applied," said Coburn. "You don't have to recreate the wheel."

The article is full of fail. But this especially grates me. For stuff like this you can't go to Best Buy and buy it. It has to be built. Now there are inefficient and efficient ways to build it but either way its going to cost a large chunk of money when you deal with these volumes.


Just get Quickbooks and have the Geek Squad help you set it up. Boom, you now have a reliable fraud protection system.
 
2012-02-24 09:31:23 AM

sprawl15: Just get Quickbooks and have the Geek Squad help you set it up. Boom, you now have a reliable fraud protection system.


I was going to say they needed to talk to that guy that put his SSN up on on the side of a bus but I hear he's too busy reading all his new magazine subscriptions.
 
2012-02-24 09:35:13 AM

jayhawk88: Well, that $7,591 figure is going to be a fun little chestnut to hear about approximately 9 billion times from whomever ends up "winning" the GOP nomination. Christ they're probably printing it up on t-shirts as we speak.


Yep. First thought I had was "I'll bet the GOP sheep-think will be since we can't detect fraud we should just abolish Medicare."
 
2012-02-24 09:36:35 AM

imontheinternet: There seem to be some people in this thread who know what they're talking about.

I've been wondering - considering how much we spend a year on Medicare/Medicaid, would it not be cheaper for the government to set up a nationwide network of free clinics and hospitals, rather than serving as a de facto insurance company for the elderly and disabled? The competition might even drive down healthcare costs.


Better that the government focus on prevention.

A nice fat chunk of Medicare/Medicaid spending is on the problems that stem from obesity - diabetes, heart disease and so forth. And yet the same federal government also bankrolls a food stamp program that drives poor people to load up on the very processed crap that leads to diabetes and heart disease. This is so profoundly idiotic that it must have been done by design.

So you start by converting the food stamp program to a food program. I have no problem with government providing nutritious food to anybody in need, as opposed to providing a piece of plastic they use on crap down at the Walmart. Not only will people get a better idea of what'll keep them healthy, the misuse of benefits would plummet. Good luck trying to trade a salad for a pack of smokes.
 
2012-02-24 09:39:48 AM

Eddie Adams from Torrance: tgregory: If a company did this to you all you'd be outraged. At least when a company farks up it's with money they've raised on their own and at their own risk. (Unless you're one of those idiots who voted for the bailouts.)

I've worked on a couple of multi-million dollar IT failures. The consultants were still paid their millions and the executives were able to either spin them as a great success, or quietly cancel them due to "changing business priorities" and collect their bonuses. The cost is written off so in a sense, the taxpayer still subsidizes the waste.


The problem is our tax code and the taxpayer doesn't subsidize the waste. Ta-da!
 
2012-02-24 09:45:25 AM
I can't believe no one has asked...

But can it run Crysis?
 
2012-02-24 09:45:49 AM

TFerWannaBe: I was thinking that too - off-the-shelf fraud detection software for Medicare? I work at a company that sells (among other things) fraud detection software for insurance companies. Coburn has absolutely no idea what he's talking about.

I wish we had bid; we could have delivered better and cheaper :)


I'm sure it could be build cheaper but I didn't think $77m was out of line for this sort of thing. The integration with legacy systems alone would be a huge chunk of money.
 
2012-02-24 09:47:47 AM

imontheinternet: There seem to be some people in this thread who know what they're talking about.

I've been wondering - considering how much we spend a year on Medicare/Medicaid, would it not be cheaper for the government to set up a nationwide network of free clinics and hospitals, rather than serving as a de facto insurance company for the elderly and disabled? The competition might even drive down healthcare costs.


How dare you suggest a reasonable, low-cost, effective, and easy to implement solution to a political hot potato. Traitor.
 
2012-02-24 09:48:00 AM

Gulper Eel: A nice fat chunk of Medicare/Medicaid spending is on the problems that stem from obesity - diabetes, heart disease and so forth. And yet the same federal government also bankrolls a food stamp program that drives poor people to load up on the very processed crap that leads to diabetes and heart disease. This is so profoundly idiotic that it must have been done by design.

So you start by converting the food stamp program to a food program. I have no problem with government providing nutritious food to anybody in need, as opposed to providing a piece of plastic they use on crap down at the Walmart. Not only will people get a better idea of what'll keep them healthy, the misuse of benefits would plummet. Good luck trying to trade a salad for a pack of smokes.


Madness! Next you're going to propose that we adjust farm subsidies to make vegetables as inexpensive as corn and HFCS.

I ate a pear the other day that was more expensive than a McDs super value meal but damn if it wasn't a farking amazing pear.
 
2012-02-24 09:49:15 AM

Gulper Eel: FlashHarry: [rickscott image 620x465]

what medicare fraud may look like.

Shiat, you could put any Florida politician in there and it would hold true. If anybody ever solved Medicare fraud in Florida, the state's economy south of Disney World would collapse.

/exaggerating
//only a little


Saw a 60 Minutes report on Medicare fraud in Miami.
Steve Kroft: "How many Medicare supply places in the phone book are fraudulent?"
Fraudster: "At least 95%."
SK: "Afraid of getting caught."
Fr: "Nope."

There are shopping centers with the only few businesses in them are medical supply shops. That never open.

/brother lives in Ft. Myers
//literally seen tumbleweed empty subdivisions
 
2012-02-24 09:55:26 AM

Gulper Eel: A nice fat chunk of Medicare/Medicaid spending is on the problems that stem from obesity - diabetes, heart disease and so forth. And yet the same federal government also bankrolls a food stamp program that drives poor people to load up on the very processed crap that leads to diabetes and heart disease. This is so profoundly idiotic that it must have been done by design.


I farking hate the 'junk food is cheaper' meme - no it's farking not! An apple is about thirty cents, a candy bar is about a dollar. Take some personal responsibility for being a fat shiat!
 
2012-02-24 09:59:16 AM

Flappyhead: jayhawk88: Well, that $7,591 figure is going to be a fun little chestnut to hear about approximately 9 billion times from whomever ends up "winning" the GOP nomination. Christ they're probably printing it up on t-shirts as we speak.

Yep. First thought I had was "I'll bet the GOP sheep-think will be since we can't detect fraud we should just abolish Medicare."


Nah, they'll just flip is as Obama being the sole reason there is any form of Medicare fraud.
 
2012-02-24 09:59:20 AM

actualhuman: Gulper Eel: A nice fat chunk of Medicare/Medicaid spending is on the problems that stem from obesity - diabetes, heart disease and so forth. And yet the same federal government also bankrolls a food stamp program that drives poor people to load up on the very processed crap that leads to diabetes and heart disease. This is so profoundly idiotic that it must have been done by design.

I farking hate the 'junk food is cheaper' meme - no it's farking not! An apple is about thirty cents, a candy bar is about a dollar. Take some personal responsibility for being a fat shiat!


Costco + massive meals + freezing leftovers lets me get a week's worth of food for 15-20 bucks. 7 pound meatloafs ftw.
 
2012-02-24 10:05:08 AM

Sudo_Make_Me_A_Sandwich: Shadowknight: Sure, if you don't mind it taking 80,000,000 years for this investment to pay off, its a huge success!

FTA: "When other benefits of the system are taken into account, such as cases referred to investigators and changes to payment software that result in automatic denial of suspect claims, the potential savings in the first six months of operation easily exceed $20 million."

Or, you know, under 2 years.


My 401k could potentially be at 80 Million dollars by years end.
 
2012-02-24 10:05:18 AM

actualhuman: Gulper Eel: A nice fat chunk of Medicare/Medicaid spending is on the problems that stem from obesity - diabetes, heart disease and so forth. And yet the same federal government also bankrolls a food stamp program that drives poor people to load up on the very processed crap that leads to diabetes and heart disease. This is so profoundly idiotic that it must have been done by design.

I farking hate the 'junk food is cheaper' meme - no it's farking not! An apple is about thirty cents, a candy bar is about a dollar. Take some personal responsibility for being a fat shiat!


Think more along the lines of comparing a loaf of processed-out-the-wazoo white bread to a similarly-sized loaf of healthier sandwich bread, or a half-gallon of shiatty Garelick milk to a half-gallon of decent milk from a nearby dairy (not necessarily organic or anything fancy).

If you're a parent on food stamps trying to do the right thing by your kids, you're farked.

Also, the local shiatball bodega probably doesn't have apples.
 
2012-02-24 10:07:20 AM

Gulper Eel: Shiat, you could put any Florida politician in there and it would hold true.


only, he was CEO of a company that was convicted of medicare fraud and paid the largest fine in history.
 
2012-02-24 10:08:58 AM

Gulper Eel: actualhuman: Gulper Eel: A nice fat chunk of Medicare/Medicaid spending is on the problems that stem from obesity - diabetes, heart disease and so forth. And yet the same federal government also bankrolls a food stamp program that drives poor people to load up on the very processed crap that leads to diabetes and heart disease. This is so profoundly idiotic that it must have been done by design.

I farking hate the 'junk food is cheaper' meme - no it's farking not! An apple is about thirty cents, a candy bar is about a dollar. Take some personal responsibility for being a fat shiat!

Think more along the lines of comparing a loaf of processed-out-the-wazoo white bread to a similarly-sized loaf of healthier sandwich bread, or a half-gallon of shiatty Garelick milk to a half-gallon of decent milk from a nearby dairy (not necessarily organic or anything fancy).

If you're a parent on food stamps trying to do the right thing by your kids, you're farked.

Also, the local shiatball bodega probably doesn't have apples.


There is a small segment that has very few options, for the vast majority of people fast food is not cheaper than cooking healthy meals.
 
2012-02-24 10:13:47 AM

jst3p: There is a small segment that has very few options, for the vast majority of people fast food is not cheaper than cooking healthy meals.


However that "small segment" has a great deal of overlap with those who need food assistance.
 
2012-02-24 10:17:48 AM
I detected $2.7M in fraud yesterday using Access, Excel, and a five year old Core2 laptop from HP.

It isn't the technology, it is the person using the tech.
 
2012-02-24 10:21:24 AM

Gulper Eel: Also, the local shiatball bodega probably doesn't have apples.


There is no supermarket within 8 blocks of my apt yet we don't live on Garelick milk and bodega candy bars
 
2012-02-24 10:27:44 AM

AngryDragon: Seriously? It's a government operation. Even if they read your comment, they would all have to go look up ROI for a definition and then take a class to understand why a realistic one is important in the grand scheme of things.


i'm sorry but government employees that matter (aka not the drones at the DMV) are generally more intelligent than you

/used to work for a govt contractor (state level)
 
2012-02-24 10:28:10 AM

Philip Francis Queeg: jst3p: There is a small segment that has very few options, for the vast majority of people fast food is not cheaper than cooking healthy meals.

However that "small segment" has a great deal of overlap with those who need food assistance.


You're leaving out the convenience factor. It's easier to pop something into a microwave than it is to cook.
 
2012-02-24 10:29:41 AM

Philip Francis Queeg: jst3p: There is a small segment that has very few options, for the vast majority of people fast food is not cheaper than cooking healthy meals.

However that "small segment" has a great deal of overlap with those who need food assistance.


There is also a large overlap between the group that don't need food assistance and those who think fast food is cheaper.
 
2012-02-24 10:30:04 AM
So Republicans are gloating that this system only *prevents* fraudulent payments from being made in the first place, rather than the much less efficient method of paying out everything and then detecting the fraud after the fact?

I wish I was surprised, but at this point there's nothing that America's Clown College can do or say that would surprise me at all anymore.

/honk honk
 
2012-02-24 10:41:52 AM

The Homer Tax: So Republicans are gloating that this system only *prevents* fraudulent payments from being made in the first place, rather than the much less efficient method of paying out everything and then detecting the fraud after the fact?


I don't see any Republicans reacting to this story one way or the other. They also benefit from Medicare being a mess.

Also, what part of "prevented just one suspicious payment" is confusing you? Once again, a government program is not performing up to its hype.
 
2012-02-24 10:42:36 AM
60 BILLION a year? Geez.
 
2012-02-24 10:55:24 AM
There's the made up, completely bullshiat $60 Billion dollar figure again.

60 Minutes misreported it and now it is the official figure on Government medical insurance fraud. Unbelievable.
 
2012-02-24 10:56:23 AM

Gulper Eel: I don't see any Republicans reacting to this story one way or the other. They also benefit from Medicare being a mess.

Also, what part of "prevented just one suspicious payment" is confusing you? Once again, a government program is not performing up to its hype.



My mistake I read the article wrong.
 
2012-02-24 11:00:48 AM

sprawl15: 7 pound meatloafs ftw.


You sound fat.
 
2012-02-24 11:03:00 AM

Gulper Eel: Monkeyhouse Zendo: If the $60B number is inflated bullshiat it's going to take longer to train the heuristics and longer to see your ROI.

The $60b figure is widely accepted, right on up to Obama's attorney general. There is a significant possibility that it is lower, but also a significant possibility that it is a LOT higher.

I base that on the statements made by Obama's recently-departed Medicare boss Donald Berwick, who pegged Medicare's annual waste (including fraud) at $150-250 billion a year.


Not this shiat again. There is no report indicating Medicare fraud is anywhere near $60B. Quit it.

Medicare/medicaid budget is about $800 Billion. Adopt single payer and you might be able to save at least 25%. So $150B-$250B in savings from waste (because of the flawed US funding model) is certainly possible but this has nothing to do with fraud.
 
2012-02-24 11:15:24 AM

mrshowrules: Medicare/medicaid budget is about $800 Billion. Adopt single payer and you might be able to save at least 25%. So $150B-$250B in savings from waste (because of the flawed US funding model) is certainly possible but this has nothing to do with fraud.


how do you figure? Medicare/Medicaid is single payer
 
2012-02-24 11:19:36 AM

skullkrusher: mrshowrules: Medicare/medicaid budget is about $800 Billion. Adopt single payer and you might be able to save at least 25%. So $150B-$250B in savings from waste (because of the flawed US funding model) is certainly possible but this has nothing to do with fraud.

how do you figure? Medicare/Medicaid is single payer


For the sickest/oldest part of the population. Expand it Nationwide and you will save a shiatload. Evidence: US health care costs twice as much as the rest of the industrialized world per capita.

Theoretically 50% savings is possible but there are costs associated with this type of transition. 25% savings withing 10 years is certainly realistic IMHO. More importantly, you can bring health care costs in line with general inflation.
 
2012-02-24 11:24:16 AM

mrshowrules: skullkrusher: mrshowrules: Medicare/medicaid budget is about $800 Billion. Adopt single payer and you might be able to save at least 25%. So $150B-$250B in savings from waste (because of the flawed US funding model) is certainly possible but this has nothing to do with fraud.

how do you figure? Medicare/Medicaid is single payer

For the sickest/oldest part of the population. Expand it Nationwide and you will save a shiatload. Evidence: US health care costs twice as much as the rest of the industrialized world per capita.

Theoretically 50% savings is possible but there are costs associated with this type of transition. 25% savings withing 10 years is certainly realistic IMHO. More importantly, you can bring health care costs in line with general inflation.


in terms of the all the money spent on healthcare, the savings should still only be those achieved via the elimination of profits and reduction of overhead, no?

The money for healthcare is still spent, it still comes from somewhere. If everyone in the country just paid for all their healthcare out of pocket, the total amount spent on actual healthcare in the US would still be the same. Am I missing something here?
 
2012-02-24 11:30:27 AM

mrshowrules: Not this shiat again. There is no report indicating Medicare fraud is anywhere near $60B. Quit it.

Medicare/medicaid budget is about $800 Billion.


Oh, did you want us to figure in state-level Medicaid fraud too? Then you're right: the combined state/federal fraud numbers will not be anywhere near $60B because they'll be a lot higher.

CMS itself estimates that in 2010 it made a total of more than $48 billion in improper payments in Medicare, and another $22 billion in Medicaid. That's about 10% of the program's annual spending. (The FBI regularly estimates Medicare and Medicaid fraud at between 3% and 10%.) It's hard to imagine any private business enduring long-term fraud losses at that level.

Yet it may be far worse than that. Malcolm Sparrow, perhaps the leading academic on health-care fraud, says CMS estimates are almost certainly wrong. "The history of the 10% figure is that it came from a GAO report from the mid-1990s," Sparrow, the chair of the executive program on regulation and enforcement at Harvard's John F. Kennedy School of Government, explains. "If you track it down--and I did--it says in that GAO report that 'some industry experts believe the loss rate could be 10%.' And because that appeared in a government report, even in an extremely vague form, it was enough to justify using it." The figure stuck because it was convenient, Sparrow surmises. "Ten percent I think served the political purpose for a good long time," he says. It was big enough so that it didn't look like people were in denial, but "not so huge as to be a public embarrassment."

Sparrow, for one, has no doubt the figure is higher. He just doesn't know by how much. "We don't know, because they [CMS] have for years persistently failed to conduct rigorous measurement studies to produce valid estimates," he says.


But as for the $60B number, do you mean to tell us that not only is Sparrow wrong, but also that CMS itself is wrong, Eric Holder is talking out his ass, and that the stat straight from President Obama's very own Medicare chief ($150-250B in annual waste including fraud) is also wrong?
 
2012-02-24 11:33:48 AM

Gulper Eel: But as for the $60B number, do you mean to tell us that not only is Sparrow wrong, but also that CMS itself is wrong, Eric Holder is talking out his ass, and that the stat straight from President Obama's very own Medicare chief ($150-250B in annual waste including fraud) is also wrong?


inb4 American Thinker link with evidence to disprove all the everyone.
 
2012-02-24 11:45:34 AM
I was assured that 80% of Medicare claims are fraudulent due to the inherent evil of socialized healthcare.
 
2012-02-24 12:02:33 PM

Gulper Eel: mrshowrules: Not this shiat again. There is no report indicating Medicare fraud is anywhere near $60B. Quit it.

Medicare/medicaid budget is about $800 Billion.

Oh, did you want us to figure in state-level Medicaid fraud too? Then you're right: the combined state/federal fraud numbers will not be anywhere near $60B because they'll be a lot higher.

CMS itself estimates that in 2010 it made a total of more than $48 billion in improper payments in Medicare, and another $22 billion in Medicaid. That's about 10% of the program's annual spending. (The FBI regularly estimates Medicare and Medicaid fraud at between 3% and 10%.) It's hard to imagine any private business enduring long-term fraud losses at that level.

Yet it may be far worse than that. Malcolm Sparrow, perhaps the leading academic on health-care fraud, says CMS estimates are almost certainly wrong. "The history of the 10% figure is that it came from a GAO report from the mid-1990s," Sparrow, the chair of the executive program on regulation and enforcement at Harvard's John F. Kennedy School of Government, explains. "If you track it down--and I did--it says in that GAO report that 'some industry experts believe the loss rate could be 10%.' And because that appeared in a government report, even in an extremely vague form, it was enough to justify using it." The figure stuck because it was convenient, Sparrow surmises. "Ten percent I think served the political purpose for a good long time," he says. It was big enough so that it didn't look like people were in denial, but "not so huge as to be a public embarrassment."

Sparrow, for one, has no doubt the figure is higher. He just doesn't know by how much. "We don't know, because they [CMS] have for years persistently failed to conduct rigorous measurement studies to produce valid estimates," he says.


But as for the $60B number, do you mean to tell us that not only is Sparrow wrong, but also that CMS itself is wrong, Eric Holder is talking out his ass, and that ...


You lack either critical thinking or reading comprehensions skills. Fraud is a subset of improper payments.

from your article:

The number repeated by most government agencies is that about 10% of CMS's expenditures are lost through fraud and "improper payments." The Government Accountability Office (GAO), the investigative arm of Congress, repeatedly labels Medicare and Medicaid "high-risk programs" because their size and complexity make them so vulnerable to fraud, waste, and abuse. CMS itself estimates that in 2010 it made a total of more than $48 billion in improper payments in Medicare, and another $22 billion in Medicaid. That's about 10% of the program's annual spending. (The FBI regularly estimates Medicare and Medicaid fraud at between 3% and 10%.) It's hard to imagine any private business enduring long-term fraud losses at that level.

What portion of the $70B ($48B + $22B) in overpayments is fraud? No one knows and no one claims to know. To have $60 Billion in fraud, you would have to show that 86% of overpayments is fraud which is just false. Waste is considered to be a greater factor than fraud so at best you get $35B in fraud.
 
2012-02-24 12:08:57 PM

Gulper Eel: But as for the $60B number, do you mean to tell us that not only is Sparrow wrong


Here is Sparrow's Senate testimony:

Link (new window)

Please indicate his estimate on fraud. He doesn't provide one. He's dealing with hypothetical only. He's not dumb enough to go on record with a fraud estimate based on absolutely no data.

How can I say Sparrow is wrong on his estimate when he doesn't give one?
 
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