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(ProPublica)   Medicare officials: after 50 years of letting the program be a magnet for every two-bit grifter with a shingle, maybe we should tighten our oversight on doctors - and that ProPublica exposé on our incompetence had nothing to do with our decision   (propublica.org) divider line 52
    More: Followup, ProPublica, Medicare, officials, planned changes, medical licensure  
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1023 clicks; posted to Politics » on 07 Jan 2014 at 9:44 AM (41 weeks ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



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2014-01-07 09:50:19 AM  
Considering they cover the sickest, poorest and oldest Americans medicare/caid does pretty good overall. Cutting out this fraud will make it even better, it's sad there's a huge group of people in our government who don't want social service programs to be effective.
 
2014-01-07 09:50:30 AM  
Won't somebody please think of the big pharma?
 
2014-01-07 09:51:51 AM  
And then, maybe can we start negotiating prices for drugs like every other large organization does instead of pulling down our pants, grabbing our knees and hoping that they're good to us and lube up this one time?
 
2014-01-07 09:54:47 AM  

pueblonative: And then, maybe can we start negotiating prices for drugs like every other large organization does instead of pulling down our pants, grabbing our knees and hoping that they're good to us and lube up this one time?


COMMIE!
 
2014-01-07 09:55:42 AM  

Headso: Considering they cover the sickest, poorest and oldest Americans medicare/caid does pretty good overall. Cutting out this fraud will make it even better, it's sad there's a huge group of people in our government who don't want social service programs to be effective.


I could really go on a rant about Medicare fraud...but I suspect the corporate compliance office wouldn't appreciate my commentary.
 
2014-01-07 09:55:47 AM  

Headso: Considering they cover the sickest, poorest and oldest Americans medicare/caid does pretty good overall. Cutting out this fraud will make it even better, it's sad there's a huge group of people in our government who don't want social service programs to be effective.


And it's large/corrupt corporations that account for the most fraud.  Look at, say, the hoverround scams, prescription drug prices, and Gov. Rick Scott.  There's a lot of money to be made bilking the federal government and a lot of those companies make campaign contributions.
 
2014-01-07 09:56:56 AM  
Don't hurt your arm patting yourlf on the back, Mr Propublica. Fraud was a feature of Medicare Part D, not a bug.
 
2014-01-07 10:00:55 AM  

Rixel: Won't somebody please think of the big pharma?


I have actually been asked why we are more likely to trust famous people speaking out on issues rather than big business, big oil and big pharma.  I wish I was kidding.
 
2014-01-07 10:01:46 AM  
Shouldn't the amount of drugs I take be solely between me and my physician?
 
2014-01-07 10:02:16 AM  
Fraud comes from two sources.  Those who claim to be sick, or claim to qualify for medicare when they don't, or when they're not sick...and also from the companies seeking reimbursement for costs they did not incur, or inflating their 'costs' to get more money above and beyond what they should be.

If we're going to crack down on the first group, we need to crack down on the second group, too.
 
2014-01-07 10:02:47 AM  

Cataholic: Shouldn't the amount of drugs I take be solely between me and my physician?


It seems perfectly reasonable that your checkbook should have a say in the matter too
 
2014-01-07 10:03:42 AM  
Fifty years? The problem got out of control under Medicare D. It says so right in the article.
 
2014-01-07 10:11:03 AM  

Satanic_Hamster: Headso: Considering they cover the sickest, poorest and oldest Americans medicare/caid does pretty good overall. Cutting out this fraud will make it even better, it's sad there's a huge group of people in our government who don't want social service programs to be effective.

And it's large/corrupt corporations that account for the most fraud.  Look at, say, the hoverround scams, prescription drug prices, and Gov. Rick Scott.  There's a lot of money to be made bilking the federal government and a lot of those companies make campaign contributions.


It's important to note that Medicare Fraud Strike Force has been doing great in that regard: in the last 7 years they've have recovered billions of dollars from abuse of Medicare Part B. Good to see Medicare is focusing in on the Part D abuses now too.
 
2014-01-07 10:11:35 AM  

Cataholic: Shouldn't the amount of drugs I take be solely between me and my physician?


they should be between you your physician and your insurance company's profit margin.
 
2014-01-07 10:12:43 AM  

Rixel: Won't somebody please think of the big pharma?


They're advertising catheters directly to consumers now...like consumers care about the features of a catheter.
 
2014-01-07 10:13:15 AM  

DeaH: Fifty years? The problem got out of control under Medicare D. It says so right in the article.


No, it's been fifty years.

I work in the healthcare industry. Defrauding Medicare is basically standard practice, and has been for decades. You just have to know how to game the system, and after 50 years, EVERYONE knows how. They've become dependent on gaming the system, in fact.
 
2014-01-07 10:13:22 AM  

Cataholic: Shouldn't the amount of drugs I take be solely between me and my physician?



As long as those drugs don't keep babies from being conceived, then the government has every right to step in.
 
2014-01-07 10:14:00 AM  

Cataholic: Shouldn't the amount of drugs I take be solely between me and my physician?


I'm now taking bets on where he goes next with this.

Odds are 2:1 that he draws an irrelevant comparison to "taxpayer funded abortion", 5:1 that he makes a privacy or freedom "argument" and 20:1 that he make a reference to "death panels" or the government denying health care.
 
2014-01-07 10:15:09 AM  

A Cave Geek: Rixel: Won't somebody please think of the big pharma?

They're advertising catheters directly to consumers now...like consumers care about the features of a catheter.



I think the diameter of the catheter might be a feature they cared about.
 
2014-01-07 10:15:31 AM  

A Cave Geek: They're advertising catheters directly to consumers now...like consumers care about the features of a catheter.


I may have never used a catheter, but I can imagine being very interested in one's features if I had to use it. Especially with regard to its comfort.
 
2014-01-07 10:16:53 AM  

A Cave Geek: Rixel: Won't somebody please think of the big pharma?

They're advertising catheters directly to consumers now...like consumers care about the features of a catheter.


Yeah that's always what I want to see while I'm eating.  Some old lady talking about the need to not re-use her cath.
 
2014-01-07 10:18:38 AM  
Americans, constituting only 4.6% of the world's population, have been consuming 80% of the global opioid supply, and 99% of the global hydrocodone supply, as well as two-thirds of the world's illegal drugs. Link
 
2014-01-07 10:22:18 AM  

Cataholic: Shouldn't the amount of drugs I take be solely between me, and my physician, and the drug company that sends him the prettiest sales rep?

 
2014-01-07 10:22:35 AM  
Weird.  Of the two, I was always under the impression that Medicare was the competently-managed one.

At least, my relative that would sometimes literally just work pro bono  rather than accept Medicaid because getting them to pay was enough of a clusterfark that it was a loss after salary hours had no such corresponding issue with Medicare, and seemed to actually consider it somewhat more reliable than many private insurers as far as having rules for what would be paid and what wouldn't set out in advance (instead of going all retardedly case-by-case, delaying the decision on payment until after the procedure was done, changing policy after the bill was sent, etc).

Then, he was mostly a surgeon and a preventative-care specialist, so I suppose he wasn't really in the branch of medicine where abuse of prescription drugs was a real concern.  Not like a menopausal woman was going to start overdosing on hormone stabilizers or anything.
 
2014-01-07 10:26:14 AM  

Satanic_Hamster: Headso: Considering they cover the sickest, poorest and oldest Americans medicare/caid does pretty good overall. Cutting out this fraud will make it even better, it's sad there's a huge group of people in our government who don't want social service programs to be effective.

And it's large/corrupt corporations that account for the most fraud.  Look at, say, the hoverround scams, prescription drug prices, and Gov. Rick Scott.  There's a lot of money to be made bilking the federal government and a lot of those companies make campaign contributions.


Yes and no.

There's a built-in problem with Medicare and Medicaid that's been there since the start - to make the program financially viable reimbursement rates have to be on the low side, but doctors and hospitals would go broke playing by the rules on those rates so to make it politically viable Medicare administrators (and state governments, in Medicaid's case) look the other way on a certain amount of upcoding, bill-padding and unnecessary treatments.

The problem comes when somebody's too obvious about gaming the system. New York just got nailed last year for $15 billion worth of Medicaid overbilling over 20 years (mainly at just one hospital) that went on with a nod and a wink from Republican and Democratic state leaders alike.

As for "corporations" stealing, well - all those fly-by-night storefront "pharmacies" in Miami that commit fraud are indeed corporations in Medicare's eyes, but only because they represented themselves as such and billed their fraud the way a legitimate provider (a corporation) would bill a legitimate treatment.

Like this.

For instance, in 2006, Miami's OIG office sent agents to audit more than 1,500 medical-equipment providers registered with Medicare in South Florida. It was an effort to gather basic information. But it had the effect of exposing the sheer pervasiveness of the problem. Agents found that one in three providers had no legitimate address, was located in an empty office, or was closed during weekday work hours on repeated visits. In 2009, Ferrer says, when home-health care fraud exploded, bills for nursing visits in Miami-Dade County exceeded the combined totals in Atlanta, Chicago, and Dallas. Last year, he adds, Medicare claims from Miami-Dade County alone totaled $558 million, more than the combined total of 23 states. More alarming, there seems to be growing evidence that Florida-style fraud is spreading to other states. Within the past two years, federal strike forces have broken up fraud rings in Atlanta, Detroit, Los Angeles, and New Orleans. In the course of those busts, they've discovered the perpetrators usually hail from Miami, or that the schemes were hatched there.

The powers that be will say that things have changed since then, and that they have a plan to combat it that they're about to put into effect - but amazingly, those plans remain in a constant state of being about to be put into effect. Note that TFA says this new anti-fraud plan will be ready to roll next January.

coughBULLSHIATcough.

New York, to go back to my first example, is being "punished" by losing $120M/year in Medicaid funding. Which sounds like putting the hammer down, except that New York was overbilling six times as much in a typical year.
 
2014-01-07 10:27:38 AM  

A Cave Geek: Fraud comes from two sources.  Those who claim to be sick, or claim to qualify for medicare when they don't, or when they're not sick...and also from the companies seeking reimbursement for costs they did not incur, or inflating their 'costs' to get more money above and beyond what they should be.

If we're going to crack down on the first group, we need to crack down on the second group, too.


The first group probably accounts for less than 25% of fraudulent payments and cost ten times as much to catch, but that doesn't matter because a Tea Partier once saw a black guy in a Cadillac, and job creators.
 
2014-01-07 10:28:32 AM  

Dusk-You-n-Me: as well as two-thirds of the world's illegal drugs. Link


imagine the percentage after they factor in Colorado and Washington's new pot smokers as "illegal drug users"
 
2014-01-07 10:33:38 AM  

Headso: imagine the percentage after they factor in Colorado and Washington's new pot smokers as "illegal drug users"


Doesn't concern me nearly as much as prescription drug use does.
 
2014-01-07 10:39:01 AM  
The headline had a colostomy.

/Probably paid for with Medicare.
 
2014-01-07 10:47:52 AM  

Lord_Baull: A Cave Geek: Rixel: Won't somebody please think of the big pharma?

They're advertising catheters directly to consumers now...like consumers care about the features of a catheter.


I think the diameter of the catheter might be a feature they cared about.


Diameter is chosen by their nurse.  Most often, the people who need catheters are in no position to put them on themselves.
 
2014-01-07 10:51:03 AM  

realmolo: DeaH: Fifty years? The problem got out of control under Medicare D. It says so right in the article.

No, it's been fifty years.

I work in the healthcare industry. Defrauding Medicare is basically standard practice, and has been for decades. You just have to know how to game the system, and after 50 years, EVERYONE knows how. They've become dependent on gaming the system, in fact.


Perhaps, but that is not what the article is about, and the area that is going to be tightened comes from Medicare D. From the article:

And the agency will tighten a loophole that has allowed doctors to prescribe to patients in the drug program, known as Part D, even when they were not officially enrolled with Medicare. Under the new rules, doctors and other providers must formally enroll if they want to write prescriptions to the 36 million people in Part D. This requires them to verify their credentials and disclose professional discipline and criminal history.

Medicare, for all its sins, is actually more efficient than private insurance. The main problem now is the gift to the pharmaceutical companies known as Medicare D.

On a more anecdotal level, my oldest brother, a life-long Michigan Republican stopped being a Republican because of Medicare D. When he could no longer cross over to Canada for prescriptions (and it became against the law for his doctor to write a prescription good in Canada), he decided that the Republicans were not really looking after the little guy. He said they were trying to funnel his money into the pockets of big drug companies, and he actually voted Democrat in 2008.
 
2014-01-07 11:08:43 AM  

Cataholic: Shouldn't the amount of drugs I take be solely between me and my physician?


It is, Medicare is saying that your physician must be a Medicare covered physician to write prescriptions that Medicare will pay. Heck, I'm pretty sure my HMO won't cover a prescription written by some out of network doctor either.
 
2014-01-07 11:20:11 AM  

lordjupiter: Rixel: Won't somebody please think of the big pharma?

I have actually been asked why we are more likely to trust famous people speaking out on issues rather than big business, big oil and big pharma.  I wish I was kidding.


ALEC agrees with you (except they are not kidding)
 
2014-01-07 11:23:59 AM  

Rixel: Won't somebody please think of the big pharma?



I would, but I'm easily distracted. Perhaps there is a drug for ...

Let's go ride bikes!
 
2014-01-07 11:28:59 AM  

Cataholic: Shouldn't the amount of drugs I take be solely between me and my physician?


The amount you take? Sure. The amount the tax payers pay for? No. If you want the government to pay for your healthcare, then voters are going to get a voice in what their money buys. If you dont like that part of socialized medicine, dont use it. You can pay out of pocket for all the name brand drugs that your scammy doctor wants to presrcibe.
 
2014-01-07 11:29:32 AM  

DeaH: Medicare, for all its sins, is actually more efficient than private insurance. T


Oh, for pete's sake - the low-overhead canard again?

It's easy to have low "overhead" when nobody wants anybody taking too close a look at who's getting paid. Then along come those meddling journalists at ProPublica to ruin everybody's ride on the gravy train.
 
2014-01-07 11:46:32 AM  

A Cave Geek: Rixel: Won't somebody please think of the big pharma?

They're advertising catheters directly to consumers now...like consumers care about the features of a catheter.


My ex-sig other used a catheter. Believe me, you want to pay attention to just what it is you're slithering up your urethra. Wrong 'features' can cause you a world o' hurt...not to mention embarrassment.
 
2014-01-07 11:51:25 AM  

DeaH: Medicare, for all its sins, is actually more efficient than private insurance. The main problem now is the gift to the pharmaceutical companies known as Medicare D.


The rebuttal to that 'study'.
 
2014-01-07 11:53:13 AM  

Snarfangel: Rixel: Won't somebody please think of the big pharma?


I would, but I'm easily distracted. Perhaps there is a drug for ...

Let's go ride bikes!


What do we want?
A cure for ADD!
When do we wan

SQUIRREL!
 
2014-01-07 12:01:51 PM  

lordjupiter: Rixel: Won't somebody please think of the big pharma?

I have actually been asked why we are more likely to trust famous people speaking out on issues rather than big business, big oil and big pharma.  I wish I was kidding.


Who should we trust on the issues?

And you can't tell people to do their own research, for a variety of reasons. Most people do not have the time, ability, or means to do their own research; and those that do often do not have the ability to distinguish the frauds from the experts and the legitimate/good articles from the crap. It makes it even more difficult when you throw in the amount of people trying to convince others that the legitimate experts can't be trusted.

So who can be trusted?

/"Somebody has to stand up to these experts!"
 
2014-01-07 12:01:57 PM  

Gulper Eel: DeaH: Medicare, for all its sins, is actually more efficient than private insurance. T

Oh, for pete's sake - the low-overhead canard again?

It's easy to have low "overhead" when nobody wants anybody taking too close a look at who's getting paid. Then along come those meddling journalists at ProPublica to ruin everybody's ride on the gravy train.


There was a lot more than that mentioned in the article:
* Percent increases in spending is significantly lower than private insurance. Your argument of no one watching would suggest the opposite be true.

*Lower admin costs tend to be a good thing. Again, if this were not effective, then Medicare would be increasing spending at or above the rate that private insurance companies do. Private insurance tends to be heavy on the administrative side.

*Medicare Advantage, legislation designed to privatize Medicare, performs poorly on every level (except private profits) compared to Medicare. On average, this privatized plan cost 12% more for the same services as regular Medicare.

And, again, the ProPublica focus was Medicare D, not Medicare as a whole. That's not to say that there are no problems. There certainly are. Of course, it doesn't help when Congress wants to pass legislation that would actually get in the way of cracking down on abuse.
 
2014-01-07 12:13:14 PM  

Headso: Considering they cover the sickest, poorest and oldest Americans medicare/caid does pretty good overall. Cutting out this fraud will make it even better, it's sad there's a huge group of people in our government who don't want social service programs to be effective.


LOL! Anyone know knows how to game the system will only dig even deeper. Any restrictions will only harm & ruin the people who are legit.
 
2014-01-07 12:15:50 PM  

TV's Vinnie: Headso: Considering they cover the sickest, poorest and oldest Americans medicare/caid does pretty good overall. Cutting out this fraud will make it even better, it's sad there's a huge group of people in our government who don't want social service programs to be effective.

LOL! Anyone know knows how to game the system will only dig even deeper. Any restrictions will only harm & ruin the people who are legit.


cool baseless assertion, bro.
 
2014-01-07 12:20:28 PM  

Headso: TV's Vinnie: Headso: Considering they cover the sickest, poorest and oldest Americans medicare/caid does pretty good overall. Cutting out this fraud will make it even better, it's sad there's a huge group of people in our government who don't want social service programs to be effective.

LOL! Anyone know knows how to game the system will only dig even deeper. Any restrictions will only harm & ruin the people who are legit.

cool baseless assertion, bro.



*And* the legit people will be covered with NaOH.
 
2014-01-07 12:23:35 PM  
so will the GOP somehow be against this?
 
2014-01-07 12:27:29 PM  

Headso: TV's Vinnie: Headso: Considering they cover the sickest, poorest and oldest Americans medicare/caid does pretty good overall. Cutting out this fraud will make it even better, it's sad there's a huge group of people in our government who don't want social service programs to be effective.

LOL! Anyone know knows how to game the system will only dig even deeper. Any restrictions will only harm & ruin the people who are legit.

cool baseless assertion, bro.


Heh. Shows what YOU know.
 
2014-01-07 12:28:05 PM  

Leader O'Cola: so will the GOP somehow be against this?


Hopefully, not.  However, my confidence in them is not very high at this point.  Knowing them, they will try something like killing Obamacare with any legislation that moves this proposal forward.
 
2014-01-07 12:28:07 PM  

Cataholic: Shouldn't the amount of drugs I take be solely between me and my physician?


Sure, but if your physician has had her license suspended, Medicare and Medicaid should not blindly pay for those pills.

From TFA: For the first time, the agency would have the authority to kick out physicians and other providers who engage in abusive prescribing. It could also take such action if providers' licenses have been suspended or revoked by state regulators or if they were restricted from prescribing painkillers and other controlled substances.
 
2014-01-07 12:40:33 PM  
dirty little secret: only two-bit grifters accept medicare.  Because the only way to make a profit off the medicare reimbursements is by grifting.
 
2014-01-07 02:13:19 PM  

DeaH: realmolo: DeaH: Fifty years? The problem got out of control under Medicare D. It says so right in the article.

No, it's been fifty years.

I work in the healthcare industry. Defrauding Medicare is basically standard practice, and has been for decades. You just have to know how to game the system, and after 50 years, EVERYONE knows how. They've become dependent on gaming the system, in fact.

Perhaps, but that is not what the article is about, and the area that is going to be tightened comes from Medicare D. From the article:

And the agency will tighten a loophole that has allowed doctors to prescribe to patients in the drug program, known as Part D, even when they were not officially enrolled with Medicare. Under the new rules, doctors and other providers must formally enroll if they want to write prescriptions to the 36 million people in Part D. This requires them to verify their credentials and disclose professional discipline and criminal history.

Medicare, for all its sins, is actually more efficient than private insurance. The main problem now is the gift to the pharmaceutical companies known as Medicare D.

On a more anecdotal level, my oldest brother, a life-long Michigan Republican stopped being a Republican because of Medicare D. When he could no longer cross over to Canada for prescriptions (and it became against the law for his doctor to write a prescription good in Canada), he decided that the Republicans were not really looking after the little guy. He said they were trying to funnel his money into the pockets of big drug companies, and he actually voted Democrat in 2008.



There has been a major change in Medicare and how it is distributed. This happened in October. The new distribution model is horrible. We are running approximately 70-80 thousand dollars behind and that isn't including the 30 thousand dollars they admitted that they owed us. It is wrecking havoc in the EMS business and is going to kill some of the smaller more innovative EMS agencies, with large agencies left standing.
 
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