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Archive for the ‘Medicare Fraud’ Category

Medicare Fraud, What Can Be Done About It?

After becoming a “retired senior”, God how I hate those words, I began watching and reading everything I can find about our congress and what they haven’t done for us as citizens. I plan to write a bit daily, all of which will be nonpartisan. I am a Republican by nature and registration but not so naïve to believe everything thing they stand for or espouse. Many people who may read this are younger and busy raising kids, working hard, and in general living their lives. The should make themselves aware and informed that the changes are coming to will greatly influence their future medical coverage as seniors.

Since Medicare is on almost all seniors’ mind these days I’ll begin with that.

FRAUD! “Guesstamates” are $60-$70 Billion a YEAR! That comes from the GAO, which means it’s a government agency and it’s likely inaccurate. After lots of research my wag is closer to $100 Billion. Those numbers don’t really “mean” much to us simply because we cannot wrap our heads around a number so huge.

Let’s ask the question, What is Congress doing to stop the fraud? Have you seen anything in the media that addressed it? No. Why is that? Simply not a controversial topic that will draw folks to tune it. It is certainly a bipartisan subject that both parties should be all over. In my humble opinion it has more than a little to do with lobbyists. From OpenSecrets.org comes this; “In all clients spent more than $3.47 billion in 2009, often driven to Washington, D.C.’s power centers and halls of influence by political issues central to the age: health care reform, financial reform, energy policy.”

Efforts to combat Medicare fraud could create significant savings for the Medicare program. Many of the schemes are widespread, well-organized, and very lucrative. The Department of Justice has requested $283.4 million to maintain and expand Medicare fraud enforcement, and has also asked for the adoption of new sentencing guidelines including stiffer penalties for those convicted of Medicare fraud. The current efforts have yielded a return of approximately $4 billion in restitution. Ah, the solution to all government issues, throw money at it! Please notice there has been NO legislature put forward to close the loop holes that Medicare is riff with. I would love opinions on this issue. If this were a public company would the owners/”us” stand for it? Would the public company fire the CEO and immediately put in controls to stop the bleeding? Hell yes! By the time Justice gets the people hired, trained, and put to work we will have had another $100 billion, or more, swallowed by thieves.

What follows is what I began this with, the FACT that congress is doing nothing to help Medicare.

Republicans will now continue to attack Democrats from the left for cutting the program through the Affordable Care Act. They will argue (as Speaker of the House John Boehner (R-OH) does) that the GOP budget preserves benefits for everybody over 54 while the Democrats cut benefits to today’s seniors and will continue to ration their care and allow the program to go bankrupt. There is very little truth to any of that. Read on, it gets better.

Of course, there are different ways to cut benefits. The liberal method is to try to get Medicare to stop paying for ineffective procedures, and to encourage measures of results rather than simply incentivize more spending. Conservatives have decided that any measure seeking to root out waste in Medicare amounts to “rationing” and is unacceptable. They prefer to put beneficiaries into private insurance, and then slowly reduce the subsidy for that insurance, so that customers can shop for cheaper plans.

What the Democrats actually did is cut the rate of growth in Medicare, reduced annual increases in payments to hospitals, skilled nursing facilities, home health agencies and other institutions to spur productivity and cut over-payments to private insurers that are not delivering value for Medicare dollars. They used that money to expand coverage to 32 million Americans — many of whom were receiving uncompensated care at these institutions — extend the life of the Medicare program and invest in new demonstration projects that aim to deliver quality care more efficiently.

Those are just the facts, and the problem for the GOP is that they actually voted for many of these reductions as part of the Ryan budget without investing the savings in coverage expansion or changing the way the government finances health care. Jonathan Cohn gets at the difference in his Kaiser Health News column:

Republicans claim, as Democrats do, that their plan will nudge the whole health care system in the direction of more efficiency — not by changing the behavior of providers, as Democrats prefer, but by changing the behavior of consumers, in ways that will create a more vibrant and competitive market. It’s a highly dubious argument, given that private insurance has higher overhead and less bargaining power than government insurance. (Remember, the Democratic plans would take money back from private insurers serving the Medicare population, for precisely the same reason.) But even if it were true, there’s no credible expert who thinks the savings from competition would be large enough to offset the massive reduction in funding Republicans have in mind.

There is also no credible research showing that forcing individuals to be more cost conscious will significantly lower national health care spending, so the GOP is voting for these cuts without increasing coverage or lowering costs.

Consider this, congress passed the Medicare bill, LBJ signed into law, and it was enacted in 1965. Prior to that only 56% of all seniors had ANY healthcare. The ones who did were paying 20% of wages to have coverage. This is per GAO. Over the years there have been some excellent plans presented in congress to fine tune Medicare, aka close loop holes, . . .all were defeated in the Senate. Sound familiar?

I’m not anti-government but I’m damn sure anti waste. The direction congress is posturing towards is geared to once again have the ‘middle class’, what little is left of it, foot the burden of cuts that don’t have to happen. What can we do about it? Whatever we decide to do but WE need to take action. I began a few months ago writing my congressmen, both state and DC. I hope others will see the need to voice their opinion.


As Paul Harvey once said, “good day”.

Semper Fi America