Medicare

The Government's Unsuccessful Efforts to Fight Health Care Fraud

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A new Health Affairs issue brief takes a look at fraud and abuse in Medicare and Medicaid. It's a big problem, According to the Government Accountability Office, those two programs paid about $65 billion in "improper payments" in 2010, which, to provide some context, is a little less than the total cost of all the additional health coverage provided under ObamaCare in 2014. The issue brief notes that the Department of Health and Human Services has been making a big push to reduce fraud in the system, and that ObamaCare gives federal health bureaucrats a variety of new tools intended to facilitate fraud fighting. The problem is that these tools haven't worked all that well so far. Doctors and other health providers already successfully convinced HHS to put one new program on hold after complaining that it would prove too burdensome. The GAO recently reported that a $102 million Medicaid anti-fraud program had caught just $20 million in fraud. Indeed, since 1986, the agency has released at least 159 separate reports on fraud in the nation's biggest government health program, Medicare. Those reports don't appear to have done much good. Last summer the agency published a report noting that the anti-fraud systems in place were "inadequate and underused." Which is why, even though I'm all for reducing fraud and waste in government health programs, I'm also pretty skeptical that the latest push will be any more successful than previous efforts. 

Read "Medicare Thieves," my October 2011 magazine feature on fraud in government health systems. 

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  1. that is a short nurse

    1. or doctor. how incredibly sexist of me

      1. 5’6″ is short? I know a lady doctor who probably doesn’t break 5 feet.

        1. She’s 5’2″.

          1. 5’2″ hits her in the eyes or eyebrows. 5’0″ is that fat line that 5’0″ is written on top of. (Former print business owner notices the spacing of the printwork.)

            1. That’s true. I didn’t look at the scale.

              1. she practically has a six inch forehead. What the hell?

                1. Probably trying out to be the next Christina Ricci.

                2. An actual fivehead.

              1. My bad.

                ‘Bout time you got one wrong.

    2. Average height of women in the US is 5’4″. So she’s actually some kind of freaking giant.

      1. Only to you, Hugh. It must be embarrassing to be shorter than joe.

        1. You know what, fuck you Episiarch. It was cold that day, okay. And I was nervous. Who wouldn’t be in front of all of those people? Plus you were standing a long way off and the lighting wasn’t really that great, so you’re really in no position to judge.

          Oh, wait, you mean shorter in height.

          1. Yes, but I had opera glasses with me.

            Maybe you had just been in the pool?

  2. As always, let me remind you that the vast majority of those “improper payments” are not knowing and willful fraud, but inadvertent errors, legitimate differences over ambiguous rules, or the inevitable result of insanely complex and ever shifting billing rules.

    1. Precisely. Not to mention the government’s definition of fraud is broader than that of any normal person. Forget to submit a report on the number of veterans you hired, and then submit a bill saying that you’ve complied with all contract conditions = fraud under the government’s definition.

      1. And most of the rest, especially in Medicaid, are “dammit, either we commit ‘fraud’ and continue to take this Medicaid/Medicare patient, or else we’ll just refuse to see Medicaid/Medicare patients at all, because if I only billed and charged what the government wanted, I’d be out of business.”

        This is certainly a lot more true in Medicaid than Medicare, since the reimbursement rates are lower. A look at how many refuse to take Medicaid patients illustrates the problem.

        One wonders how much lower the Medicare and Medicaid patient acceptance rate would be without fraud.

    2. R C Dean| 8.23.12 @ 6:22PM |#
      “As always, let me remind you that the vast majority of those “improper payments” are not knowing and willful fraud, but inadvertent errors, legitimate differences over ambiguous rules, or the inevitable result of insanely complex and ever shifting billing rules.”

      IOWs, pretty much how the IRS defines ‘fraud’ to collect penalties.

  3. The GAO recently reported that a $102 million Medicaid anti-fraud program had caught just $20 million in fraud.

    In the fevered mind of the statist liberal, that’s $102 million of !!!JERBS!!! and $20 million in savings. That equals $122 million of moving forward. Why you gotta hate Pete?

  4. Obama says the health care act will target $800 million in fraud and waste. So if they know it’s there, why did they need legislation to target it? Just do it. Or shut the hell up because you and your Congressional buddies already baked the fraud and waste into the program.

  5. The GAO are masters of exageration. Pay no more attention to them then any other government agency attention whores.

  6. Lind to medicare thieves does not work

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