Medicare's Fraud Prevention Systems "Inadequate and Underused"

According to the Cato Institute's Michael Cannon, the Government Accountability Office has issued 159 separate reports on fraud prevention in Medicare since 1986. It doesn't appear that they did any good. The Associated Press reports on a new GAO report that once again highlights the system's failure to prevent fraud: 

The federal government's systems for analyzing Medicare and Medicaid data for possible fraud are inadequate and underused, making it more difficult to detect the billions of dollars in fraudulent claims paid out each year, according to a report released Tuesday.

The Government Accountability Office report said the systems don't even include Medicaid data. Furthermore, 639 analysts were supposed to have been trained to use the system—yet only 41 have been so far, it said.

Earlier this year, the GAO issued a report estimating that Medicare made $48 billion in improper payments in 2010—much of it fraud—equal to almost 10 percent of the program's total spending.

Comments

[Tony]

Earlier this year, the GAO issued a report estimating that Medicare made $48 billion in improper payments in 2010?much of it fraud?equal to almost 10 percent of the program's total spending.

Government make a mistake? That's unpossible?

[sarcasmic]

Just pass a law. That will stop it. Laws are magic.

[Tony]

How dare you impugn the majesty of government!

[Tim]

Y'all bend over and touch your toes, the Doc's gonna show you where the subsidy goes.

[Brett L]

See, here's my problem. Fraud and mispayment at 10% may be high, but there is a minimum that is >0%. I'd be surprised in a system of that volume if it got below 4%. That's assuming they are willing to say no on the false positives that come out of the anti-fraud measures.

The problem isn't the size of the fraud, its the size of the system.

[Bingo]

It's also the fact that those that run the system really don't have any incentive to minimize fraud since their funding is achieved through coercive means in the first place.

[NoVAHockey]

look up operation wheeler dealer. it's a couple of years old and addressed wheelchair fraud. a ring of Nigerian immigrants figured out billing medicare for complex power wheelchairs was safer and more lucrative than dealing drugs.

[Abdul]

One of the problems with Medicare fraud, is that much of it could be eliminated by simple statistical analysis of claims. Certain outliers are so improbable, they almost certainly are fraud.

The IRS uses a system like this to catch cheaters. The goverment has a different incentive when it's paying out the money.

[Hank]

It took a helluva long time, but I hereby voice my support for a voluntary registration system for comments.

SF's analogy of a friend shitting on your rug while wearing a mask tipped the scale.

[SugarFree]

All my best analogies are feces-based.

[Kool]

ROADZ!! (or something)

[cynical]

Cool, now you just need to pay for it.

[16th amendment]

There are 3 types of fraud. Which ones are present in the report?

(1) Direct fraud where you bill for services that weren't even rendered. I read in an AARP publication that this really happens.

(2) Second type of fraud is where you provide services, but the services are totally unnecessary.

(3) The third type of fraud is when the services are unnecessary but required so that doctor's don't get sued for negligence.

[Otto]

You're also forgetting service categorization fraud. Something is done, but it is categorized as a higher cost service.

This can be deliberately fraudulent, or done through definition fatigue.

[16th amendment]

This potentially looks like a subset of (1), namely billing for a higher cost service which was not rendered.

There is also a fourth or fifth type of fraud, which is

(4) Raising the price of the service because you know the government will cover it. Maybe raise the price 180% (from $1000 to $2800), then government cuts the subsidies to you 50% (from $2800 to $1400), leaving you with a net 40% increase from your original price.

[sarcasmic]

There is no Medicare fraud, because that would mean government bureaucrats made mistakes.
Since we all know that government bureaucrats are super beings incapable of error, Medicare fraud simply cannot exist.
If it did then we would have to admit that government is imperfect.

[16th amendment]

Maybe they could create a new internal affairs division to monitor fraud in the medicare program. The cost of this new division would be no less than $40B (which is the estimated amount of fraud). That would certainly make the government happy.

[16th amendment]

Maybe they could create a new internal affairs division to monitor fraud in the medicare program. The cost of this new division would be no less than $40B (which is the estimated amount of fraud). That would certainly make the government happy.

[SugarFree]

Government Accountability Office

Just like the way a junkie in the gutter is accountable to himself.

[Warty]

I'm holding you accountabilabuddyable!

[Bee Tagger]

Uh, maybe if you stop telling people how easy it is to defraud Medicare, not as many will do it.

[R C Dean]

Far and away the biggest category of "fraud" involves billing for services that were rendered, were medically necessary, but were not documented appropriately.

For example: You needed a shot, I gave you a shot, I billed for the shot I gave you, BUT I didn't write down that I checked five systems before you got the shot. aHA! Fraud.

So, keep that in mind when you see these kinds of articles.

[16th amendment]

I don't understand what you're saying.

[Brett L]

Eh. I do contract work for the FLDOH, and we get plenty of emails trumpeting the suspension of doctors and billers who engage in outright fraud such that their licenses are suspended.

[Jacquelyn Finney]

Obama's War on Medicare Whistleblowers
Medicare isn't finding fraud, because it isn't looking. Instead, government bureaucrats and judges have declared war on whistleblowers, who report Medicare.
I was a federal Medicare fraud investigator. Eradication of fraud, waste, abuse, and mismanagement by politicians, health plans, medical groups, and special interests would fund medically necessary health care for all Americans.
Kaiser Permanente and the Rawlings Company are running a health insurance subrogation scam, "Kaiser Permanente Plunders Patients' Piece of the Pie," that defrauds 8.6 million patients in California alone.
http://www.youtube.com/watch?v=v0h7tUymj2 San Francisco Judge Richard Seeborg admits that a whistleblower's case against Kaiser Permanente was "plagued" with errors/abuse by Justice Department lawyers, judges, and court administration that created a hostile environment for whistleblowers.
Motion and Order posted on, http://www.judicialactivism.info/PACER- QUI TAM MOTION 5-27-10.pdf
Jacquelyn Finney MPA

[P Brooks]

Raising the price of the service because you know the government will cover it.

You mean like when a "price ceiling" becomes a "floor"?

[Nike Dunk High]

thanks