Medicare pays out $47B on questionable claims, but you know, you can't tell those doctors how to

[RB TexLa]

practice medicine. That 5 to 3 percent overhead that people brag about with medicare is what allows the probably 35 or so percent fraud rate. Of course we could hire investigators and actually prosecute the doctors doing the stealing. 20 to 15 years in prison and lifetime revocation of their medical license.




WASHINGTON – The government paid more than $47 billion in questionable Medicare claims including medical treatment showing little relation to a patient's condition, wasting taxpayer dollars at a rate nearly three times the previous year.

Excerpts of a new federal report, obtained by The Associated Press, show a dramatic increase in improper payments in the $440 billion Medicare program that has been cited by government auditors as a high risk for fraud and waste for 20 years.


http://news.yahoo.com/s/ap/20091114/ap_on_bi_ge/us_medicare_fraud

[Vinnie From Indy]

1. This is an area that should reward whistleblowers with a percentage of funds recovered

Or, some other arrangement.

[kristopher]

2. The legislation is going to address this.

Note the issue is fraud and waste, not just fraud. A lot of the problem is the lack of guidance on what works best versus what doesn't or what is a better choice because of cost. The panel of physicians they envision will provide such guidance and that is expected to greatly reduce waste.

In the area of fraud, what you say is true. It takes money to police any policy and this is no different. I don't think the issue with the insurance companies is the amount they spend defending against fraud, they spend it figuring out how to get new people to enroll and how to get rid of people who are sick.

Does that cost as much as policing fraud? I don't know but it looks like we'll find out.

[rocktivity]

3. The fraud isn't all on the payee's end

Until last week, I worked for a mobile x-ray service. Medicaid pays 80% of the bill--when, that is, they actually pay the bill.

We billed an average of $200 for a case. At an average of ten cases a day, six days a week, and fifty-two weeks a year, that's close to half a million dollars we should have been getting. Well, there's at least that much worth of cases piled up that haven't been acknowleged, let alone paid. We've had claims denied, but they tell you why (misspelled name, wrong ID number), you make the fix, you re-submit, and you get paid. Medicaid is even worse--they won't pay a dime of the remaining 20% of the bill, and we can't bill the patient for the difference. They owe at least $100K.

After submitting at least seven months' worth of 2008 claims TWICE with no substantial results, I started looking for another job. I couldn't stand the thought of continuing to waste more of my time and the money I was being paid (which, not surprisingly, wasn't much).

:(
rocktivity

[Luminous Animal]

4. It is an estimated 12.4% fraud rate.

Where you got the 35% fraud rate is between you and your ass.

So even with 5% overhead + 12.4% fraud, Medicare "overhead" is less than the insurance companies 25-30%.

But I am with you in regards to prosecuting doctors. Don't waste time & money on patient co-conspirators, they are a miniscule part of Medicare fraud. Go after the doctors and go after them hard.