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Stealing from the Sick
Over the next year, Presidential candidates will prattle about health care, but none of them will talk about the elephant in the operating room–the massive fraud that bleeds the system.
Another piece of the picture emerged yesterday in a whistle-blower lawsuit that, according to the New York Times, claims “improper sales practices, together with erroneous accounting, are invisibly draining millions of dollars out of vital public programs like Medicare through overcharges or unauthorized uses…systemic fraud across a whole network of companies and more than 7,000 health care institutions.”
Cynthia Fitzgerald’s sickening account of her experience in the medical supply business involves kickbacks, bribes and bid-rigging. For complaining about such illegalities, she was, of course, fired as a trouble-maker.
Now she is suing under the False Claims Act which, according to Taxpayers Against Fraud, has helped the government recover more than $20 billion from health care companies since 1986, $5 billion of it in the last two years.
But that may be small change compared to the blood money that is hemorrhaging everywhere. According to the FBI, health care crime by hospitals, doctors, pharmacists and other care providers is adding up to between $60 and $100 billion a year in the system that is saving us from socialized medicine.
If we could stop that, it would pay for almost six months of the war in Iraq.
Cross-posted from my blog.
17 Responses to “Stealing from the Sick”
[...] House Stealing from the Sick » This Summary is from an article posted at The Moderate Voice » Domestic and international news [...]
True! True! True!
Wasted, as well as stolen, money is the name of the game in every department and every program.
While this kind of article usually elicits the ‘big governemtn’ mantra, greed and irresponsibility will surface under any system with impunity.
The reaction to exposes like this is usually only about 5 minutes of dismay and tut-tutteing.
Just look at an area like Tampa, stints, joint replacement and glaucoma are cash cows with doctors milking the system. Add cosmetic surgery to the mix, why work in a complicated fields like OB/GYN or neurosurgery when trivial procedures aren’t harassed by malpractice attorneys and much is done outpatient or just a day or two.
Awhile ago we were talking about possible causes in the surge in healtcare costs, with some voices simply writing it off on the costs of R&D. People like this bring to light that for the wishful thinking it is, and first step on the road to reigning in the ballooning costs is shining a big bright light on the practices of the back end of the business side of healthcare.
If the Democrats want to sell their healthcare plans, they should really address this part of it:
How to stop waste and abuse.
Also, like Rudi points out, elective cosmetic surgery should not be acceptied as part of regular health care.
Re law suits, I agree that they have to be reigned in with award limits and other guidelines. However, I would definitely not go so far as to call all lawsuits frivolous. There are too many mistakes, and those responsible should be held accountable. There is too much of a buddy system in health care, where professional loyalty among peers trumps personal responsibility. There must be a rational middle ground, where a broken finger nail is treated differenrly than the amputation of the wrong limb.
As usual, you get it wrong again. What is being exploited here is that part of our health care system that already is socialized, Medicare.
“As usual, you get it wrong again.”
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As usual, you get it wrong again. What is being exploited here is that part of our health care system that already is socialized, Medicare.
I would guess that the same fraud is found in HMO’s in the private insurance end. Record keeping in hospitals and doctors offices is a disgrace. In the age of laptops, RFID and Blackberry’s(handheld PA), patients are given the wrong medications because of antiquated paper records. It’s not the COMMIES DLS.
http://healthcare.zdnet.com/?p=471
7-11 and WalMart are using barcodes and moving to RFID tags to fully automate inventory at their stores. Notice how grocery stores use barcodes/lasers, do you think the old paper system was cost effective compared to laptops, hand-help PA and wireless networks. If A&P can track a dozen eggs throughout the system, why doesn’t the medical field follow suit. Does Brown and FedEx carry around catalog’s /reams of paper to tract shipment?
And in the prescription area:
http://www.scienceblog.com/community/older/2000/D/200003636.html
Automation and IMS could save lives and maybe help against malpractise, but may in medicine are dragging their feet. The cutting edge in heart surgery now uses robots. Yet, paper office records are handled by teen agers making just over minimum wage…
Rudi, I’m fully aware that there are problems in the health care system outside the scope of Medicare; I was simply correcting the original author’s incorrect language (and not in an improper way at all — AHEM).
Just looking for a moment at something notorious in Medicare, EPO (the red-blood-cell-boosting drug used by dialysis and cancer patients and also abused by athletes), what we have includes: a) a long-established monopoly provider of the original drug; b) “rebates” to users of the drug for purchasing it. This encompasses activities outside the strictly-defined public sector, i.e., Medicare or Medicaid.
Another abuse is self-referral, referral of patients to facilities owned by the physicians themselves. In past years there were problems with home health care companies, and nowadays you probably know about the problems with imaging centers as well as clinical laboratories.
(Then there is the practice of markup on tests that are done by different people altogether.)
Health Net and other insurers are in the news for illegitimate rescissions of insurance policies to those who become sick.
The scope obviously goes beyond the public sector. But Medicare fraud is a fact, and of course Medicare is not “saving us from socialism” but instead is socialism.
DLS – The US is the only health care system without socialized medicine in the West. But corruption and antiquated technology are bigger problem. Despite the Republican meme, we don’t have a free market. The US auto companies are/were behind the Japanese and Europeans in upgrading technologies, medicine also has the same problem without competition.
The above report is eight years old, why the wait to change an antiquated system?
The Wingnuts want a national ID supplies bu MC or Fedex, I want my doctor using something better than a Commodore 64, if they are even using that. I have personal knowledge in regards to the following.
http://www.roboticsonline.com/public/articles/archivedetails.cfm?id=1663
http://henryfordmacomb.com/body.cfm?id=48365
http://www.zoominfo.com/people/Harrington_Steven_93694170.aspx
If the Internets exploded in 10 years, whats wrong with medicine? Politics is the least of medical problems.
Actually, we do have socialized medicine already, for the elderly (and some for the poor as well). That is a fact even if health care providers remain at least nominally private (as they would under the Conyers-Kucinich “Medicare for All” scheme).
Right, corruption is outside (beyond) the scope merely of Medicare (and Medicaid). Technology, I wouldn’t view as a panacea. What I would concentrate on would be the relatively low overhead of Medicare and a potentially great reduction in complexity, not to mention ending problems with delay or refusal of insurance companies to pay claims if Medicare were extended to everybody. The Medicare bureaucracy is large and cumbersome, but the insurance companies are cutting their own throats by deliberately making it complex and difficult to get claims paid, each company having a different system to some extent (a single system, even using “old” tech, is better than multiple all-new systems), all playing games with claims.
To the extent we’d be switching from private insurance (a false name; normally it is pre-paid health care, not true insurance) to Medicare, we would exchange one set of problems for another (including more Medicare fraud), but given the problems with the insurance-HMO-based private system, a conversion to Medicare might appeal to many (at least one’s health care would be paid for fairly promptly, one would hope). Ten years ago the thought of extending Medicare to everyone would have still been radical, truly extremist, and even silly; nowadays that is a mainstream and even a common thought. “It’s not just Conyers and Kucinich,” even if their plan has some radical elements that disqualify it from serious consideration. (Forcing all medicine to go public non-profit without compensating for 20-30 years’ lost profits [growing annually] is obviously an unconstitutional seizure, a confiscation, i.e., government theft, for example.)
Readers shouldn’t forget that while Massachusetts has been in the news for its state health-care plan, more important is a much larger, more important state with worse health care problems, the state that normally leads the others and sets the “national direction” on most matters: California.
Pew (from Stateline) has a new report about California and health care here.
Arguments over free-market vs socialized systems of delivering health care skip ove the main point: greed, fraud and waste, as well as human error, will persist regardless of the political ideology behind it.
Human nature is at work, regardless of the framework.
The methods that will decrease waste, fraud and error in socialized medicine are the same methods that will work to do so in privatized medicine. Greed goes where money flows; it’s not choosy about the political ambience.
In medicine, like in any other area of public concern, there is a distinct difference in how the mission is defined. If public service is the mission, the goals and implementation will be decidedly different than if profit is the mission.
Choosing profits as the mission has both a positive and a negaive impact. Competing for profit may spur competition and consequent improvement in the final priduct. On the other hand, it can make all sorts of collusion attractive for the sake of increasing profit.
The business model across the board has changed in that serving the community (consumers) used to be part of the definition of doing business but is so no longer.
In areas like news coverage and medicine, serving the community as the mission simply can not be discarded without incurring drastic consequences.
The claim that free markets haven’t worked because they haven’t been given the chance to be really free is inapplicable when public service is at stake. Making choices in the provision and consumption of health care is not anything ike making decisions in offering and buying a washing machine.
From a pragmatic viewpoint, then, I like the socialized angle on health care because it will never abandon meeting public sevice obligations as the mission. Recognizing the need to deal with costs, however, I also recognize the need to utilize whatever is necessary and prudent from the business world to accomplish the goals.
I wouldn’t expect any system to be perfect, as perfection is possible only in paradise. I would expect any system to be followed carefully and to be adjusted accordintgly when problems rise to the surface.
Well, in addition to fraud, there’s the profits in the system (successive markups). By going to non-profit the advocates of government (I won’t use the stupid term “single-payer”; WHO’S THE PAYER?) believe the savings from the elimination of profits as well as unnecessary complexity will enable everyone to be given health care.
That remains to be seen, much less proven, and even if this were initially achieved, long-term health care costs are only going to rise, and rise very substantially.
What has happened in some instances to keep costs down is to restrict or reduce payments to physicians and other health care providers, to the point where they have lost money relative to inflation over several years, or are actually losing money, i.e., operating at a loss, which they cannot sustain.
In some cases, what happens is that private insurance providers are charged much, much more than Medicare, in part to recoup money lost from Medicare underpayment.
This in turn has led Medicare to shift costs onto the private sector, and in at least one case recently, has extended the period of private insurance coverage for something before Medicare pays for it. The insurers and large employers hate it, the providers and presumably those in the federal government love it; the difference in what is charged is on the order of 2-3 times for insurers what Medicare pays ($120,000-180,000 annually vs. about $60,000). You can read about this example here.
Today, they private insurance system does not work, creating enourmous xost to the economy as a whole and to each of us individually.
Imagining thet only bad things will happen if the system is changed one particular way, is just that -imagining, and very incomplete imagining, at that.
In the meantime, many of the factors contributing to higher costs have been identified, and they have an equal chance of being dealt with, reagrdless of the nature of the reforms. It’s a side issue, although one with a primary importance.