# Medicare for All: What to be done to reduce fraud? **URL:** \ **Category:** Great Debates\ **Created:** [February 26, 2020, 4:37pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559 "2020-02-26T16:37:31Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [February 26, 2020, 4:37pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/1 "2020-02-26T16:37:31Z")
\*(Thread meant to be a debate about only one specific aspect of Medicare-for-All: fraud - not a broader discussion of Medicare or healthcare in general) \* Around a decade ago, CBS reported that [Medicare was averaging **$60 billion** in fraud every year.](https://www.cbsnews.com/news/medicare-fraud-a-60-billion-crime-23-10-2009/) I haven’t seen the data in the years since, but it may have been continuously the same up to the present day as well. Now, if Medicare is expanded to cover all of America, will it come with some major reforms to prevent fraud? The system would be much larger then, and therefore have far more claims to investigate and monitor (but presumably the Medicare administration’s workforce would be greatly expanded as well.) Or would the potential criminal payouts be a lot lower since the government would be negotiating for lower prices with legit healthcare providers (therefore meaning that even phony medical billing could only net in a smaller amount as well?) ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [February 26, 2020, 4:56pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/2 "2020-02-26T16:56:28Z")
I think it will be a lot easier to pick up the patterns since Medicare will be paying for almost all of it: for example you can see that it will be impossible for a doctor to be treating this many patients–there aren’t enough hours in a workday. Also Medicare for all will be able to switch to other payment alternatives to pay for service with the existing extraordinarily complex payment schedules. ---
**Author:** ![Ruken](https://avatars.discourse-cdn.com/v4/letter/r/f475e1/32.png) [@Ruken](https://boards.straightdope.com/u/Ruken)\ **Post date:** [February 26, 2020, 5:01pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/3 "2020-02-26T17:01:49Z")
Here is a 2014 CBO report on “How Initiatives to Reduce Fraud in Federal Health Care Programs Affect the Budget”, PDF: [https://www.cbo.gov/sites/default/files/113th-congress-2013-2014/reports/49460-ProgramIntegrity.pdf](https://www.cbo.gov/sites/default/files/113th-congress-2013-2014/reports/49460-ProgramIntegrity.pdf) They invoke a “coming soon” estimate of fraud that I haven’t found, and note that it’s hard to quantify. Are you interested in fraud and only fraud, or any improper payments (i.e. also waste and abuse)? I think it would be useful to know how most medicare fraud is caught today. Audits? Internal whistle-blowers? Suspicious patients? I’ll see what I can dig up. ---
**Author:** ![BeepKillBeep](https://avatars.discourse-cdn.com/v4/letter/b/9e8a1a/32.png) [@BeepKillBeep](https://boards.straightdope.com/u/BeepKillBeep)\ **Post date:** [February 26, 2020, 5:07pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/4 "2020-02-26T17:07:42Z")
Probably the same thing that happens in Canada and the UK. The government agency responsible for the administration of the system investigates possible cases of fraud. These guys ([Highlights from Counter Fraud 2020 | News | NHS Counter Fraud Authority](https://cfa.nhs.uk/about-nhscfa/latest-news/highlights-from-counter-fraud-2020)) estimate that fraud costs the public 1.27 billion pounds a year, on a budget of 122 billion points per year. Or 1.04%. I cannot find it but I’m sure I saw somewhere that fraud in the medicare system in Canada is about 2% of costs. How much money is lost to fraud in the USA under the current system? ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [February 26, 2020, 5:29pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/5 "2020-02-26T17:29:46Z")
Medicare fraud is currently estimated to be around $60 billion per year. In order to reform that they would have to change the rules so that fraud can preemptively be used to not pay. Currently all claims must be paid immediately and then Medicare has two months to prove fraud to get the money back. ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [February 26, 2020, 6:33pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/6 "2020-02-26T18:33:13Z")
As long as it prevents the rampant fraud by insurance companies and hospitals currently practiced against their customers, it will be an improvement. Even if it’s the most corrupt national healthcare system ever. ---
**Author:** ![mikecurtis](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mikecurtis/32/3284_2.png) [@mikecurtis](https://boards.straightdope.com/u/mikecurtis)\ **Post date:** [February 26, 2020, 7:42pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/7 "2020-02-26T19:42:50Z")
why are you singling out medicare fraud? Med ins fraud in the private sector accounts for 3% - 10% of claims, which is $90B - $300B per year. And while Medicare’s 9% is near the top it’s still within the range. [https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud/](https://www.nhcaa.org/resources/health-care-anti-fraud-resources/the-challenge-of-health-care-fraud/) ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [February 26, 2020, 9:58pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/8 "2020-02-26T21:58:52Z")
> [@BeepKillBeep](#): > > Probably the same thing that happens in Canada and the UK. The government agency responsible for the administration of the system investigates possible cases of fraud. > > These guys ([Highlights from Counter Fraud 2020 | News | NHS Counter Fraud Authority](https://cfa.nhs.uk/about-nhscfa/latest-news/highlights-from-counter-fraud-2020)) estimate that fraud costs the public 1.27 billion pounds a year, on a budget of 122 billion points per year. Or 1.04%. I cannot find it but I’m sure I saw somewhere that fraud in the medicare system in Canada is about 2% of costs. > > How much money is lost to fraud in the USA under the current system? Maybe Canada just runs a much tighter ship or the USA is just more prone to fraud. But going by the figures in that CBS article, it look like American Medicare fraud runs at about 11-12% of the costs compared to the two percent of Canada’s. ---
**Author:** ![mikecurtis](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mikecurtis/32/3284_2.png) [@mikecurtis](https://boards.straightdope.com/u/mikecurtis)\ **Post date:** [February 27, 2020, 12:31am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/9 "2020-02-27T00:31:53Z")
Let’s take a breath there, Speedy. That CBS report is from 2015 and can charitably be labeled as sensational. Let’s look at numbers for 2017. [ul] [li]Medicare had a total outlay of $720B, and received $111B in premiums for a net expenditure of $609B (that includes administrative and other related expenses.)[/li][li]The GAO lists the total fraud for that year at $52B [/li][li]That’s 8.5% of net or 7.2% of gross expenditures.[/li][li]Fraud, or “improper payments” includes “mistakes”, “inefficiencies”, “bending the rules”, and “intentional deception”[/li][/ul] > **[FY 2017 Budget in Brief - CMS - Medicare](https://www.hhs.gov/about/budget/fy2017/budget-in-brief/cms/medicare/index.html)** > > FY2017 Budget in Brief- CMS Medicare > **[Medicare: Actions Needed to Better Manage Fraud Risks](https://www.gao.gov/products/gao-18-660t)** > > Medicare improper payments were estimated to be about $52 billion in fiscal year 2017. As program spending increases, the cost of fraud could increase... > **[gao-18-660t.pdf](https://www.gao.gov/assets/gao-18-660t.pdf)** > > 1028.69 KB ---
**Author:** ![BeepKillBeep](https://avatars.discourse-cdn.com/v4/letter/b/9e8a1a/32.png) [@BeepKillBeep](https://boards.straightdope.com/u/BeepKillBeep)\ **Post date:** [February 27, 2020, 1:30am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/10 "2020-02-27T01:30:26Z")
> [@Velocity](#): > > Maybe Canada just runs a much tighter ship or the USA is just more prone to fraud. But going by the figures in that CBS article, it look like American Medicare fraud runs at about 11-12% of the costs compared to the two percent of Canada’s. Maybe, but then is this really about medicare for all? It is impossible to predict whether switching to universal healthcare (UHC) will increase fraud, decrease fraud, or have no real effect. It seems like UHC has less fraud, but as you say this could be one of those cases of “American Exceptionalism.” From that context, I don’t know enough about fraud in the USA to really make an intelligent statement about it one way or another. So, I’ll bow out for the moment. If I have some time later, then maybe I’ll try to check out some papers on medical fraud in the USA. ---
**Author:** ![kanicbird](https://avatars.discourse-cdn.com/v4/letter/k/5f8ce5/32.png) [@kanicbird](https://boards.straightdope.com/u/kanicbird)\ **Post date:** [February 27, 2020, 1:42am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/11 "2020-02-27T01:42:43Z")
> [@DrCube](#): > > As long as it prevents the rampant fraud by insurance companies and hospitals currently practiced against their customers, it will be an improvement. Even if it’s the most corrupt national healthcare system ever. Not the best phrasing, however does make a point, if M-F-A even with fraud is overall more cost effective then what we currently have it’s a plus for the citizens of the US. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [February 27, 2020, 1:48am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/12 "2020-02-27T01:48:30Z")
> [@Velocity](#): > > Maybe Canada just runs a much tighter ship or the USA is just more prone to fraud. I choose to assume Canadians are just better people. This assumptions proves useful in many situations when contrasting Canada to other nations. ---
**Author:** ![steatopygia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/steatopygia/32/3132_2.png) [@steatopygia](https://boards.straightdope.com/u/steatopygia)\ **Post date:** [February 27, 2020, 1:52am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/13 "2020-02-27T01:52:42Z")
> [@Bryan\_Ekers](#): > > I choose to assume Canadians are just better people. This assumptions proves useful in many situations when contrasting Canada to other nations. As an American, I’ll agree. ---
**Author:** ![leahcim](https://avatars.discourse-cdn.com/v4/letter/l/b4bc9f/32.png) [@leahcim](https://boards.straightdope.com/u/leahcim)\ **Post date:** [February 27, 2020, 2:18am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/14 "2020-02-27T02:18:54Z")
> [@Velocity](#): > > Maybe Canada just runs a much tighter ship or the USA is just more prone to fraud. I’d say the latter, just because in the USA healthcare is so expensive, that people who can’t afford it (or who can afford it, but just don’t want to pay) are motivated to commit fraud to get it. If your health expenses are covered either way, there’s not nearly as much motive for fraud. ---
**Author:** ![squeegee](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/squeegee/32/14537_2.png) [@squeegee](https://boards.straightdope.com/u/squeegee)\ **Post date:** [February 27, 2020, 3:14am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/15 "2020-02-27T03:14:40Z")
> [@leahcim](#): > > I’d say the latter, just because in the USA healthcare is so expensive, that people who can’t afford it (or who can afford it, but just don’t want to pay) are motivated to commit fraud to get it. If your health expenses are covered either way, there’s not nearly as much motive for fraud. Why would you think patients are the main source of fraud in Medicare (or regular healthcare for that matter)? I’m not sure how that would even work – Grandma makes an insurance card on her laser printer, presents it for care and… well, she’s found out immediately. It seems far more likely that healthcare providers & insurers are the main source of any fraud in (this or any) system. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [February 27, 2020, 3:41am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/16 "2020-02-27T03:41:04Z")
> [@squeegee](#): > > Why would you think patients are the main source of fraud in Medicare (or regular healthcare for that matter)? I’m not sure how that would even work – Grandma makes an insurance card on her laser printer, presents it for care and… well, she’s found out immediately. > > It seems far more likely that healthcare providers & insurers are the main source of any fraud in (this or any) system. I’m sure the providers are the main source of Medicare fraud - but as far as the patients go , if 60 year old grandma takes her 65 year old sister’s Medicare card to a new doctor, how will they know it’s not hers? Some offices have asked for ID if I’m a new patient, but not nearly all. ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [February 27, 2020, 7:51am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/17 "2020-02-27T07:51:07Z")
As long as you have payment per item of service, you multiply opportunities for fraud. The NHS largely operates on predetermined block budgets and salaried staff. Frauds tend to be around things like awarding supply contracts rather than core medical services. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [February 27, 2020, 8:19am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/18 "2020-02-27T08:19:29Z")
> [@doreen](#): > > I’m sure the providers are the main source of Medicare fraud - but as far as the patients go , if 60 year old grandma takes her 65 year old sister’s Medicare card to a new doctor, how will they know it’s not hers? Some offices have asked for ID if I’m a new patient, but not nearly all. Hey, you know what would really go a long way to ending fraud like that? Give the 60 year-old her own card. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [February 27, 2020, 10:54am UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/19 "2020-02-27T10:54:34Z")
> [@doreen](#): > > I’m sure the providers are the main source of Medicare fraud - but as far as the patients go , if 60 year old grandma takes her 65 year old sister’s Medicare card to a new doctor, how will they know it’s not hers? Some offices have asked for ID if I’m a new patient, but not nearly all. In a system where everyone gets their care for “free” then the only way by which the 60 year old can defraud the system is by fooling the doctor into getting treatment she doesn’t really need. I’m not sure it would be that much of a problem and the only way of guarding against that in any system is to have medical specialist assessing people…which they do. ---
**Author:** ![Gyrate](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gyrate/32/3588_2.png) [@Gyrate](https://boards.straightdope.com/u/Gyrate)\ **Post date:** [February 27, 2020, 12:25pm UTC](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559/20 "2020-02-27T12:25:00Z")
> [@Bryan\_Ekers](#): > > Hey, you know what would really go a long way to ending fraud like that? Give the 60 year-old her own card. Yes, this is kind of important. If the “fraud” you’re trying to prevent is people not eligible for the system fraudulently claiming that they are, making everyone eligible eliminates all that fraud in one fell swoop. It doesn’t do anything about doctors making false claims, but then that’s a problem for every system. [Next page](https://boards.straightdope.com/t/medicare-for-all-what-to-be-done-to-reduce-fraud/848559.md?page=2)