Crooked-Doctor Component of Health Care

While the nation suffers a political migraine over health care reform, news spotlights an overlooked aspect of the mess–that the current system is turning doctors into thieves.

Federal authorities yesterday arrested 30 physicians and other medical providers for $16 million of fraud as part of a series of crackdowns in what the FBI estimates to be between $60 and $100 billion a year of health care crime.

The healers this time are accused, among other neat tricks, of billing Medicare for liquid food provided to dead patients and $4000 “arthritis kits” consisting of braces and heating pads.

Such a financial and moral breakdown was dramatized in a New Yorker article last month that President Obama has made required reading in the Oval Office.

Written by a New England surgeon, Atul Gawande, it reports on the small town of McAllen, Texas, which has the second-highest per-capita Medicare costs in the country (after Miami) and twice those of neighboring El Paso with no discernible health benefits as a result of doctor-owned hospitals, surgery centers and diagnostic-test facilities.

This kind of borderline thievery transcends the question of public or private health insurance, calling into question the fees-for-service nature of American health care.

“Providing health care is like building a house,” Dr. Gawande writes. “The task requires experts, expensive equipment and materials, and a huge amount of co├Ârdination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later?”

He points to alternatives such as the Mayo Clinic and other “accountable-care” systems…

Read the rest of this entry.

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Author: ROBERT STEIN

  • Silhouette

    They just now figured this out? Not. It's been the longest standing joke at the expense of everyone since I was knee high [and I ain't no spring chicken].

    Next area of waste control: $1,000 toilet seat covers and other military waste and military-subcontractor scams. I grew up in a military town. Three of my friends in highschool had fathers in the mob and you couldn't throw a stone without hitting a mob family connected with leeching off the military. They go hand in hand. Good old Dick Cheney's holdings and connections with military $camming need the light of day shone on them. Yes, that would be an excellent place to start.

  • casualobserver

    Note to Demcare proponents………find the same story in the annals of private insurance claim reimbursement.

    As fraud prevention and detection is a major source of the higher “administrative overhead” that Greendreams and other government healthcare proponents say argues for their case, thanks for highlighting this oxymoron in their argument.

  • DaGoat

    This post is really mixing two topics. The arrests were made for Medicare Fraud. The McAllen example is much more likely to be Medicare waste, which is due to providers doing too much either because they are awarded for doing so (higher reimbursement for procedures) or penalized for not doing so (fear of lawsuits).

    The way to address the waste is to equalize the profit incentives between procedures and conservative therapies, and enact tort reforms.

  • Lit3Bolt

    The thing is DaGoat you're paid by procedure, not for having a long heart to heart with someone about losing weight and eating right. The simple, conservative therapies are time intensive and are heavily dependent on subjective things like the relationship that person has with his or her doctor. In short, they don't pay, so you get waste and fraud so people can make more money.

    I think the REAL elephant in the room when it comes to socialized medicine in the United States is that the US is so different from the majority of other First World countries. Our citizens are fatter and unhealthier and suffer more violence than all those other nations, and all of it can't simply be applied to poor access to healthcare in the US or a shitty healthcare system. Socialized medicine works in most other nations because they don't eat bacon with every meal.

  • shannonlee

    Which does beg the question Lit…

    Why should the rest of us pay the health care for our undisciplined, unhealthy, and crack/alchohol/cig addicted fellow citizens?

    Just putting it out there…

  • pacatrue

    I go back and forth on this precise matter, Shannon, but to play the devil's advocate: “same reason we pay for education for teens who don't care or can't take advantage of it.”

  • Lit3Bolt

    I honestly don't know shannonlee. The more I think about it, the more I get that the US has to change fundamentally in some way. I think decriminalization of drugs would be a good first step. Don't encourage it, but don't put someone in jail just because they used it. We tried putting everyone who drank booze in jail, too, and look how that turned out. That idea leads directly into prison reform, which leads to police and crime reform, which leads to treatment reform, culture change, school reform, etc…a lot of things suddenly become possible.

    At the same time though, that callous attitude towards your fellow citizens might be to blame as well. Nobody is poor because they want to be. Nobody gets sick because they want to get sick. Contrary to the myth of the American Dream, some things can't be solved by tons of hard work and a little Yankee ingenuity by yourself. So let's not get too moralistic about people who stray from being perfect little citizens. People are not poor or fat or on drugs because they committed some Original Sin and deserve it. And it has little or nothing to do with willpower, or rather I should say willpower isn't something that's innate that people can summon up to vanquish all. Discipline is taught, not written into DNA. Many many people just don't have the good fortune of someone teaching it to them.

    So, I guess we should pay for their health care for the same reason we all pay for a military to defend all of us, pay for roads we all drive on, and pay for schools our children go to. It gives everyone the opportunity to become happy, productive citizens again. Or we could treat the poor and needy and addicted like trash, try imprison them at every opportunity, treat them like criminals and continue to be SHOCKED that when treated like criminals they act like ones.

  • DLS

    This is actually only one of the defects with Medicare that should logically be addressed before moving to extend Medicare to more people, or to absorb VA and Medicaid, etc., into Medicare (conversion) — all of which are not only logically but in other ways so obviously superior to the current stupidly rushed effort.

    * * *

    “Our citizens are fatter and unhealthier and suffer more violence than all those other nations”

    1. That hasn't stopped proponents of government health care from saying that we also are wealthier, so we can afford to join the rest of those nations (in fact, the wealth to some actually “means” we should).

    2. Food faddism and elitism have no place in the generation and direction of government policies. We should _never_, in this country, _ever_ be subjected to government ads, much worse regulations and laws, governing what we eat, what exercise we choose or don't choose to engage in, and so on.