Medicare's $77 Million Anti-Fraud System Catches $7,591 in Fraud


The Obama administration has been promising for a while now to crack down on Medicare fraud, which by some estimates costs taxpayers $60 billion a year. Officials at the Department of Health and Human Services have touted increases in the agency's fraud prevention budget, as well as new technologies designed to track, identify, and prevent fakery within the billing system. Under President Obama, anti-fraud efforts have been given "historic support," according to Medicare's website.

What the administration hasn't done, however, is make a sustained case that their anti-fraud efforts are actually producing consistent results. Which may be somewhat difficult when faced with stories like this one, reported by The AP:

Congressional officials say a $77 million computer system launched last summer to stop Medicare fraud before it happens had prevented just one suspicious payment by Christmas.

That saved taxpayers exactly $7,591.

Hoping for much better results, a disappointed Sen. Tom Carper says that when he saw the number he wondered if Medicare had left out some zeros.

The Delaware Democrat was expecting the system would finally allow Medicare to stanch a $60-billion-a-year fraud hemorrhage. Now lawmakers are worried about its future performance.

This news comes just a few months after Medicare announced that it would be putting several of its shiny new anti-fraud programs on hold after backlash from doctors and other health providers. 

Read "Medicare Thieves", my October 2011 magazine feature on Medicare fraud. Thanks to NCPA's John Goodman for the link

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  1. Remember, gang: The CBO projections that show that Obamacare is “paid for” assumes that we’re going to be able to cut half a trillion in “waste, fraud, and abuse” from Medicade and Medicare over the next decade.

    1. Only $499,999,992,409 to go!

      1. Let me be clear: It’s these sort of investments that will define my Presidency for decades to come.

        1. decades? at this rate, the fed will implode much sooner than that.

  2. The squirrels got Suderman, I saw it. Must be nice to be the one holding the double barrel squirrel gun though.

  3. Peter, your Alt Text-ing has become EXQUISITE.

    I hereby declare you to be “damned near Cavanaugh-Gillespie-level alt texter”. That’s on the Almanian scale – your mileage may vary.

    *fist bump*

    1. Agreed. But there can be only one Arch-Alt-Texter, and her name is Lucy.

      1. Don’t be; anything that seems like a compliment from Almanian is actually an insult.

    2. In the middle of replaying Oblivion. Not getting much sun. I am that of which you speak.

      1. Skyrim is lots of fun, but consolitus has set in 🙁

        1. …everywhere I go now.

          *tears stream down cheeks*

        2. Playing Morrowind for the first time on my PC, love the fact that I can use mods. My computer is too old to run Skyrim, so I had to get it for 360.

          1. My favorite of the series. Be sure to add Tribunal. There are merchants in Mournhold who put the Scamp in Caldera to shame.

          2. My computer is too old to run Skyrim, so I had to get it for 360.

            Silly console people. That xbox money coulda bought new guts for the computer.

  4. Sqwerlz defeated…for now

  5. Keep in mind, also, that Medicare rules classify even inadvertant technical errors, not to mention billing disputes which boil down to judgment calls, as “fraud.”

    So when someone says “Medicare fraud is umpty-zillion dollars”, they aren’t talking about intentional-misrepresentation type fraud. They are talking about billing errors.

    1. Shouldn’t “inadvertant technical errors” happen in both directions, and mostly cancel themselves out in aggregate?

      1. Except that there’s a fun law called the false claims act, which makes these errors result in treble damages plus $11,000 civil penalty per error.

  6. Romney should have the inside track on Medicare fraud:

    The case concerning Damon Clinical Laboratories is relevant because 1) Romney was a director of the firm while the fraud took place; 2) the fraud appears to have ended only after Bain sold its stake in the firm; 3) Romney personally earned nearly $500,000 from the sale of Damon; and 4) Romney’s statements about what he knew and when he knew it have been inconsistent.

    We’re going to hear a lot more about Damon if Romney becomes the GOP presidential nominee. The American Federation of State, County and Municipal Employees union is already running an ad in Florida that highlights the case.

    (Washington Post)

    1. Clinical lab billing, in particular, is an area where inadvertant billing errors are rampant, for a lot of reasons having to do with such esoterica as “unbundling”, what constitutes a “physician order”, and the mismatch between modern lab equipment, the reports it generates, the “unbundling” rules, etc.

      I’ll need to see a lot more before I ding Romney (who I despise) as a fraudster.

      1. Give you an example:

        A physician says he wants blood tests A and B run on a patient twice a day. That goes into the patient record. The nurses draw the blood and send it to the lab twice a day. Has the physician “ordered” those tests? What if he didn’t sign every single request for labs that was generated? If he didn’t, were those tests “fraudulent”?

        The lab gets the blood, and puts into one of their gizmos, which runs tests A through E, because that’s what it does. Medicare rules say tests A through E have to be “bundled” and not billed separately. But tests C through E were not ordered, so the hospital can’t bill for them, and can’t bill the bundled test. Can it unbundle and bill for A and B even though the entire bundled panel was performed?

        This goes on. And on. And on.

        1. You’re right. In this case Damon was found guilty of fraud of about $100 million. The fraud began when Bain bought the company and Romney led the Bain team.


          Its amazing how Romney is skating some of these issues.

          1. You’re right Shrike political corruption is a terrible thing.

            1. Do you think I care when Team Blue does it?

              1. Shrike is quite correct! When progressives…members of Team Blue if you will…. engage in activities that the uneducated observer might consider corrupt it’s really that they don’t understand the economic and fiscal issues involved. I stated …quite correctly I might add…in my most recent column…….that when “we” do it it is only with the purest of motives!

                1. So… Romney is responsible for the wrongdoing?

                  Hell, I’m not voting for him, but that’s pretty fuckin’ weak, shrike.

        2. Give you an example:

          I’m never going to the doctor again.

    2. Romney committed fraud = it’s okay when things I like commit fraud. It’s bad in both cases. Do you think people here like Romney?

  7. Notice how they gave Hamburglar red gloves? It’s so he’ll always be caught red-handed…

    1. Those are the Gloves of the Sanguine Swiftblade.

  8. The real tragedy is that you wasted perk points on pickpocketing.

    Sorry, that was mean.

    1. That’s almost as bad as putting them in Speech.

      1. If I replayed Morrowind I would likely put my major stats in mercantile, speech (also effects merchant disposition), alchemy, mysticism, enchantment, and security. Likely the best combo for making the big bucks off of potions and filled soul gems early on so you can buy the other skills without repetitive hack and slash.

      2. Hey, early on I was dying for coin, and bumped my exchange rate a little with a couple of Speech perks. Now, I’m rolling in it, and would love those points back (MOAR DESTRUCTION! MOAR!)

        I don’t know whether to hope they give us a way to reset our perks, or make us live with perks that made sense early on, but don’t later.

        1. Destruction has been nerfed too much in Skyrim. I find the best schools for magic are conjuration and illusion.

          1. You know you’re doing okay when you can relax and watch your two conjured dremora slice and dice your opponents.

      3. Nothing beats backstabbing a Golden Saint for a one stroke kill. It is even worth forfeiting her soul.

  9. Not that it’s all one person, but you don’t fraudulently make $60 billion per year by being easy to catch.

    In my experience, a fancy computer system is not going to be able to detect fraud for long. Whoever is committing the fraud will find holes in the system as fast as the old holes are plugged. Only highly trained and expensive humans will be able to stop it.

  10. I would hope that any congressional hearings on this include the one person who was caught.

    I would love to see how dumb that person is.

    1. They’ll still be smarter than some members of Congress. I guarantee it.

    2. They made up that fake payment, they didn’t actually catch anything.

  11. Medicare’s $77 Million Anti-Fraud System Catches $7,591 in Fraud

    That would be a rate of return of… 0.010%.

    At that rate, it would take the government about 1 million years to get back their original investment. I call that sustainable stupidity.

    1. Hey, if we prevent even one dollar of fraud, that is money well spent!

  12. I knew an old woman who swallowed a fly…

  13. End medicare and you end medicare fraud.

    The more (unnecessary) systems created, the more (unnecessary) fraud is created. At some point, you have so many systems EVERYBODY accepts fraud as s.o.p. and everyone cheats (at varying levels) to the point where honesty is completely removed from the population.

    1. In Soviet Union, fraud find you!

  14. Does Medicare cover arrows to the knee?

    That looks like the guy that stole my sweetroll.

  15. Congressional officials say a $77 million computer system launched last summer to stop Medicare fraud before it happens had prevented just one suspicious payment by Christmas.

    Well, I would call that a success! Imagine a system purported to foresee the future and already with evidence to prove it can!

    Because, normally and on this Universe, fraud is only known after it happens, not before. You cannot claim to be the victim of fraud if you haven’t participated in it first – get it?

  16. I’m about to have to pick sides in the civil war. Yeah, the Imperials are kind of dicks, but the guy running the Stormcloaks really kind of got up my nose when I dropped in on him.

    Any thoughts?

    1. Which would you rather see burn, Solitude or Winterhelm? Other than that, which side you pick doesn’t really have any lasting effect on the game.

      1. That being said, Ulfric is still a dick while you’re standing over him about to deliver the killing blow.

      2. I’ve got a nice house in Solitude. Although, I think that’s where the wife is, too.

        Tough call.

        1. You can move the house.

          1. Technically, I can move the wife, but yeah.

            Now I’m curious, though. If I burn Solitude while Mrs. Dragonborn is cribbing there, what happens to her?

            1. Your house will remain unscathed. Protected by the gods, I think.

    2. Oddly for a libertarian from DaggerFall to Skyrim, I’ve always played a loyal subject of the empire. I hate going native. Just hate it.

      1. Daggerfall

        1. …the Empire is relatively respectful of civil liberties.

          1. Well, there is religious freedom.

            1. Meaning a small pogrom against a certain religion.

              1. Talosians are infidels!

          2. Imperial taxes seem to be a flat 10%, so that’s great.

            But there is a War on Skooma. Known here on out as the WOS.

            1. Oh yeah…

              You can marry whomever you wish. Even cross-species weddings are cool in the eyes of Mara.

    3. I sided with the Empire. Same issue. And I was an Imperial, anyway.

    4. It’s a tough decision, but for libertarians, a familiar one: Basically, you have to choose between statist cosmopolitan assholes and mildly racist nationalist hicks.

      1. Ah, but we do have a third category with local government: mildly racist cosmopolitan assholes.

      2. thread winner!

  17. But think of all the jobs and economic expansion the new computer program generated!


    1. But think of all the jobs and economic expansion the new computer program generated!

      But think of all the jobs and economic expansion fixing the new computer program will generate!

      Yes! That’s what I meant to say.

  18. “””Under President Obama, anti-fraud efforts have been given “historic support,” according to Medicare’s website”””

    I don’t think that’s true. Obamacare’s ratio of medical services money vs medical administration money has put a dent in the ability to prevent fraud.

  19. Now lawmakers are worried about its future performance.

    When dealing with the government, past performance is indicative of future results.

  20. What the fuck kind of computer system costs $77m?

    1. The ‘jobs saved or created’ kind.

    2. One that doesn’t work worth a shit, apparently.

      1. so, Apple?

        1. Network guys were too busy getting Sebelius’ iTwiddleStick connected to the Exchange server, and neglected to make the rest of the network actually work.

          1. Network Guys: “Look, if the bitch hadn’t lost her password 5mins after we gave it to her…”

  21. Repurpose the DEA to investigate all new medicare providers and pop in randomly on those who bill medicare any significant amounts for equipment.
    When agents did investigate, they found storefronts fraudently billing for wheelchairs, oxygen generators, and millions of bucks of other equipment. And prosecute the family and friends of patients who go along with schemes in exchange for a piece of the take.

    1. whoa, whoa, whoa, slow down.

      using the DEA to go after actual crime? that’s just crazy talk.

  22. Didn’t DoJ just announce charges in a huge $350M plus medicare fraud in texas?


  24. We could have saved $77M in government fraud.

  25. This author is totally ignorant. The Anti-Fraud provision has saved over $1.0 bil. in 2011. Not a bad investment.

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