Health Care Crime
Of all the ills of American health care, least visible is the pervasive fraud it encourages in everyone involved–doctors, patients, labs, hospitals and, most of all, the insurers who manage the mess.
One small symptom can be seen in a New York Times report of 91 Medicare audits showing “widespread violations of patients’ rights and consumer protection standards†in private drug plans for the elderly that were supposed to save them money but, in some cases, are endangering their lives.
Slap-on-the-wrist fines totaling $770,000 of 11 companies won’t make a dent in the billions they are raking in from the most vulnerable Americans, who might have been helped by authorizing Medicare to bargain with pharmaceutical companies or allowing medications to be imported from Canada instead of devising new ways for insurance companies to fleece them.
Other clues about the enormity of health care fraud emerged this summer when the new Justice Department Medicare Fraud Strike Force announced measures to crack down on medical companies that send phony bills or provide excessive treatments, pointing to 2,400 investigations last year and warning that more cases were on the way.
The FBI, which estimates health-care stealing to total between $60 and $100 billion dollars a year, lists a few of the ways it’s done:
Hospitals, doctors, pharmacists, and other care providers submit fake bills for services never rendered–or overcharge for those delivered.
Service providers bill insurance for unnecessary and costly procedures.
Doctors sell prescriptions to patients for cash.
Companies charge insurance for expensive equipment but provide poor substitutes.
Crooked M.D.s entice patients to visit their offices for “free services” or gifts, then steal their personal information and use it to file fake claims.
If you have a strong stomach, you can Google “health care fraud†and get 23 million hits, many reporting convictions of providers across the country. But reading too many may make you sick and in need of medical attention.
Cross-posted from my blog.
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10 Responses to “Health Care Crime”
Let’s not forget alot of needless surgery that pads the physicians pockets. Joint replacement and stints are cash cows, with many surgeries done for the doctors bottom line, not the patients health.
Baseball, hot dogs, apple pie, and “upcoding”…
The problem will be much worse if children or the entire population get on Medicare. You’re warned.
Being from Michigan and talking to many people in Windsor Ontario I hear that a large majority in Canada love their system. The US is the only Western industrial country without a single payer system, that speaks much louder than anything about Medicare.
We have a problem with Private Military Firms in Iraq. Are the same people clamoring for elimination of domestic federal programs also clamoring for the eilimination of PMFs?
We have a problem of waste and corruption in the awarding of gov. contracts to private contractors of all kinds. Stop the practice?
DOD contracts have huge problems. Plus, it has never set up a responsible bookkeeping system. Should we get rid of the DOD?.
I’ll start taking warnings about governmentt programs setiously when an equal aooportunity rule is adopted tor misdeeds in all progroms, government run and contracted.
Picking and choosing according to personal preferance is not acceptable.
The answer is, of course, oversight, transparency and accountability.
Where money flows, there will always be waste and corruption, unless proper safeguards are put in place. It matters not one iota through which mechanism the money is passed. on.
Medicare is a “single-payer” system, for the existing beneficiaries. (Who is the payer? Government, i.e., the taxpayers.)
One of its problems is fraud.
I agree medicare fraud is rampant. I know when my grandmother was in a nursing home they charged for all sorts of stuff that never occured. Heck we had bills from the home, and one from a hospital, for services supposedly rendered over a week after she had passed. Talk about low.
However, fraud in general is rampant in the medical industry regardless of your insurer. I worked for a private medical insurer and there was even fraud internally. Imagine that. No idea how much, as that was not data/area I really worked with in that regard, but I still learned of it from time to time.
I really can’t see how medicare, or private insurance, matters a jot, at least fraud wise anyway. Scamming one way or the other seems par for the course in the industry.
It’s considered worse with Medicare because of the size of the program, its complexity, and the lure of easy money (whereas insurers are likely to second-guess claims and frequently deny legitimate claims, something I’m seeing right now as an insured individual, in fact).
Not that that doesn’t discourage people from advocating Medicare for all — their reply is that yes, fraud is a problem, but they still claim large cost savings and a guarantee everyone gets medical care if we had Medicare for all. Fraud can be addressed and remedied at the same time the program is expanded.
DLS,
The insurance companies often don’t deny claims accidentally while guarding their interests. They have people who are dedicated to the idea of denying legitimate claims based on anything they can come up with. This is fraud just as bad as anything you think happens in Medicare, just aimed at the customer. It is considered SOP on their part. Conservatives complain about fraud but have no real interest in doing anything about it. Missouri Republicans last year refused to pass a law to investigate fraud by providers but are really happy to go after patients. So much for worrying about defrauding the government.
Sure, medicare is a big program but insuring people any other way is just a lot of small programs that add up the same way.
And, I agree more effort should be set on checking fraud. Along with a bit more realism in setting reinbursement too. A lot of that fraud is incentivised due to barely breaking even or going negative on treatment/care I bet.
Medicare/aid seems no more complex than any other insurace. X is covered (or not) for Y though Dr. Z on dates blah blah blah… Okay they check age too. But that is the small potatoes when it comes to complexity. I wrote my past co’s elegibility check myself so I know wherefor I speak, or at least think I do. Now add in gap insurance and things get a bit trickier I agree…
I don’t know how much cost savings we would get from the program. Other countries do see large savings and improvement in precieved care quality… But that will not neccessarily translate to our environment I grant.
It would however be more equitable… It would help prevent people choosing between bankruptcy or their health… And it would hopefully catch expensive issues early, when they are cheaper to treat. Granted the patient would have to follow through and not all will, but still it would improve at least somewhat in that regard
[Medicare For All]
I don’t know how much cost savings we would get from the program.
Nobody knows. (I don’t trust the figures in the Conyers-Kucinich bill.) Cost savings would only happen early in the transition; medical care continues to increase in costs and our population will be more costly to treat as it ages. That there should be savings initially, I don’t think it’s possible to dispute.
[Righty anti-collectivist least-common-denominator remarks suppressed *wink*]
Yes.
This may happen sometimes.