There’s also the fact that anti-fraud measures are administrative costs that make Medicare look less cheap. Medicare seems better than private care if you don’t count fraud as a cost.
Forget Medicare-what about the 6.5 million people receiving SS, all over 112 years old?
Link:http://www.newsmax.com/US/ssa-audit-millions-dead/2015/03/10/id/629253/
And again, an Inspector General makes a report noting a serious deficiency and nothing is going to be done about it.
The illegal immigrants who have stolen these numbers should be deported to Albania.
This - all of this. A lot of what is labeled fraud in those reports includes these types of cases. The Medicare paperwork trail is there to prevent fraud, but it also creates fraud where none truly exists. There is a reason that there are consultants who work with medical practitioners (for a price, of course) to help them safely file and code for reimbursement. The note taking requirements, the fact that the same procedure can be coded in multiple ways, the issue of “you forgot to put X on the top of the sheet”, etc. makes Medicare (and Medicaid in many states) a dangerous proposition for some doctors.
Is there fraud? Absolutely.
Is there a need to make this a smoother process for providers? Absolutely.
I’ve run into the same mindset within any insurance company where prior authorization or medical review is needed. Oh, you wrote down that the patient is taking X, Y, and Z? Well, you didn’t check the little box telling us you wrote it down, so denied. Very common everywhere.
True, and should likewise be stopped or at least minimized. But Medicare makes it much more difficult to file and win an appeal than most private insurance.
You might want to read that article before you cite it. Those 6.5 million are not receiving payments. Many of them are in fact *making *payments for benefits they will never receive.
Maybe, but it is statistically impossible to have that many people alive at ages greater than 112. Poor record keeping? Any life insurance company could figure out that most of these people are frauds. at present, there are only a handful of people alive, over the age of 112. Of course, the SS Administration employs actuaries and statisticians-what do these people do?
Try to manage the other 66 million living people and the vast array of claims, submissions, counter claims and payouts.
And, again, how hard do you want to make life for people who are flagged in error? I’ve got a patient who, at the ripe old age of 85, was informed by the social security administration that she is dead. Made it really hard for Section 8 to pay her rent, or for her to get medical care or her to renew her state ID, or even to pay her phone bill. It took more than three years to straighten that out. You’d think that showing up to the local SSA office while breathing might fix it, but nope.
Ultimately a lot comes down to complex databases and IT infrastructure needing to be designed. However those type of hidden, pedestrian projects tend to get cut, or shrunk or derided when the large undiscovered linkages showup and drive costs through the roof.
You don’t see the crime in paying out billions to fraudulently obtained SS number holders? I guess a few hundred billion are nothing to worry about. I see a big problem with this.
I think the headline on that article is deliberately misleading.
But what can you expect from Newsmax?
In anything in the real world, government or private, there is going to be some level of fraud. The question is what is the cost of preventing that fraud? There is a point of diminishing returns, where the cost of catching fraud is higher than the cost of the fraud.
Beyond that, there’s the problem of being so diligent that you end up denying legitimate claims. What level of incorrect denials is acceptable? And what is the financial cost of handling appeals?
If we want 0% fraud and that is our only goal then the easiest and cheapest solution is to not have a program to begin with. However, we’ve decided as a nation that the humane and decent thing to do is to provide for the medical care of older Americans. If we want to do that then some level of fraud is inevitable. I don’t like it. You don’t like it. Nobody likes it. But there it is.
And keep in mind that the same cost benefit considerations regarding fraud also apply to private insurers, only they have more incentive to err on the side of denying legitimate claims.
Where do you get the few hundred billion estimate from?
I didn’t say that. I said that one must consider the side effects of reforms, and those side effects include the impact on those identified incorrectly. If we’re going to start putting words into each other’s mouths, I’ll wonder why you want little old ladies to starve to death without medical care or housing.
Did you already forget to re-read your cite? “a few hundred billion” isn’t mentioned anywhere in it. Plus, your cite is about people fraudulently paying *in *to social security, which I can’t say is high on my list of concerns.
Medicare suddenly got busier.
I used to work with medical legal professionals. One of them told me the hardest part of the job was convincing their clients (doctors and MHOs) that certain actions they were contemplating were in fact medicare fraud. Because a lot of things that look like they make perfect sense from all points of view (such as doctors going in together to buy some piece of expensive medical equipment to use on their patients) are in fact Medicare fraud.
Books on health care law, including Medicare, took up many feet of their bookshelves. With ACA, they would have needed a bigger bookcase, except now it’s all electronic.
Of course there are a lot of people intentionally committing large-scale Medicare fraud, but they know they’re doing it and how to cover their tracks, being that they’re organized crime.
Medicare fraud costs up to $60 billion a year, by comparison allowing Medicare d to negotiate drug prices would only save $16 billion a year. Fraud is the bigger expense.
I thought the aca had provisions to fight fraud, but I don’t know the details.
Can you give a short explanation of why doctors going together to buy medical equipment is fraud? I don’t disbelieve you. I’m genuinely curious.
I suspect it’s because if doctor’s own some expensive piece of equipment then they have a financial incentive to prescribe the use of that equipment where if the equipment is owned by some third party (a hospital, for example) then they have no incentive to falsely prescribe it’s use. Am I correct?