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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 7
    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 (29 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
4 votes:
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 09:56:56 AM
2 votes:
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 09:51:51 AM
2 votes:
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 04:47:59 PM
1 votes:

globalwarmingpraiser: 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.


That's the plan.

Dwight_Yeast: Cutting Medicare fraud is one of the ways we're paying for the ACA


The whole premise of the ProPublica investigation is that we're NOT cutting the fraud - and even when caught red-handed being asleep at the controls the Medicare powers-that-be try selling us some happy horseshiat about how they totally have an anti-fraud plan that's going to kick in...um, next year.

Which is what they've been saying with pay-and-chase for ages now.

1965: LBJ signs Medicare into law. And there is much rejoicing and not a whole lot of auditing. I mean, who's going to steal from a health care program for the elderly? Inconceivable.

1970: Hmm. Hospital spending is up 37% in five years since Medicare started. Wonder why...Nixon says eh, we'll figure it out later after the next batch of checks clear. Besides, John Lennon might be up to something subversive. Better keep an eye on that feller and that oriental broad too.

2000: Bubba signs law banning Medicare from paying unlicensed orthotics/prosthetics providers seeing as there's a lot of dodgy operators and paying and chasing all the fraudulent claims is getting old. Medicare: wait, we're supposed to what? We'll get right on it.

2005: Bush signs law banning Medicare from paying unlicensed orthotics/prosthetics providers seeing as there's a lot of dodgy operators and paying and chasing all the fraudulent claims is getting old. Medicare: yeah, I think, like, somebody told us that before. We'll get right on it. But first we have to pay for these 21,000 artificial limbs down Florida way. Looks legit to us.

2006: Yay for Medicare part D. This won't be quite the fraud magnet regular Medicare is. Or maybe it will.

2008: Maybe if we ditched pay-and-chase we could stop sending tax dollars to Russian identity thieves.

2009: We'd love to stop pay-and-chase if we had the resources. If only there was some government spending program, some kind of stimulus, that would fund this worthy cause.

2010: We're going to scrap pay-and-chase.

2011: See? Here's our plan.

2012:  And what's a plan without hearings?

2013: We totally have a handle on this fraud thing (kind of) and see? We got back four billion dollars of the hundreds of billions that have been ripped off over the years, but hey...

2014: (TFA) We are going to totally NAIL all that fraud. Starting next year.
2014-01-07 10:26:14 AM
1 votes:

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 10:02:16 AM
1 votes:
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 09:55:47 AM
1 votes:

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.
 
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