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Keep in mind, these criminals couldn't do this with patients who were willing to go along with it... It takes only ONE patient complaint to investigate it and they been doing this for a couple of years... any complaints? apparently most people over there lack the moral and ethics to do anything... says a lot about those communities...
Very Valid points -
My insurance company sends me a letter asking me to review the detailed bills I get from the Hospital, Doctors and other providers - and to let them know if I dispute any of the individual charges on those bills - either for services claim were rendered or, for items charged for but not received -
To get a handle on fraud and over charges - it HAS TO BE cooperative effort --- the insurance company AND THE PATIENT.
This information is so false. I close relative of mine is in the FBI. His job is to find Medicare fraud. The government does have an incentive, and does investigate as well as prosecute, Medicare fraud.
Forum members, please don't mistake a post here which is a personal opinion as fact!
Here is a website for reporting any suspected Medicare fraud to the government. It was last updated in 2008.
private insurers have an incentive to find fraud, but government does not.
First, private insurers must build provider networks. These networks can include high-value providers and exclude low-quality providers. Except for certain circumstances, including criminal acts, Medicare is forbidden from excluding poor quality providers. It lets in everyone who signs up. So one question to ask is, will the public plan have Medicare's indifference to quality -- or invest in the cost of a network?
Really sandy Medicare lets anyone in that signs up? BS Here's some of the hoops they have to jump though to get accepted.
Quote:
Second, private insurers must negotiate rates. Medicare just fixes prices using a statutory and regulatory scheme. And anyone who imagines a public plan would be less costly than private plans must keep the following issue front and center: In the many procedure categories where Medicare's statutory price does not cover full provider costs, shortfalls are shifted to private payers who end up subsidizing the public program. So, will a public plan negotiate rates or simply use fiat as a means of gaining subsidies from private insurance?
Insurance Companies need the costs to stay artificially high so people have to buy their product. Medicare does not just pick a number out of the air to pay providers. They pay what is usual and customary for that service.
Quote:
Third, private insurers must combat fraud -- or go out of business. Indeed, these payers have every incentive to invest in antifraud personnel and strategies down to the point where return and investment are equal. But anyone who thinks that a public plan could serve as a "yardstick" for the private sector needs to consider Medicare's dismal record with regard to fraud, waste and other abuse.
You read about medicare providers being busted for fraud. You know what antifraud is for private insurers, it's an add on TV just before they jack up the price.
In fact, the total amount of Medicare fraud is unknown. The government does not measure or estimate fraud in its programs; instead, it measures payments made "in error." According to Medicare's own most recent data, payments made in error amount to over $10 billion annually. (Medicaid's payment errors in 2007 equaled a whopping $32.7 billion, according to a report by the Department of Health and Human Services.) Others have claimed Medicare's payments made in error are much higher. Even with the inclusion of the budget of the inspector general for the Department of Health and Human Services, Medicare spends less than one-fifth of 1% on antifraud measures -- a small fraction of what private plans invest in their efforts to build a network of honest providers. (wsj)
You wanna know how fraud works in the private sector it's this simple. It's done with double billing and it's 100 billion dollars a year.
i went back and looked at the site again. you are showing me a site where you can report fraud, where is government incentivized to fight fraud on that site? that is why i posted the MSNBC report, because government really does not have any true incentive to fight fraud. medicare will stay in business, until it runs out of money, whether the government challenges fraud or not.
i went back and looked at the site again. you are showing me a site where you can report fraud, where is government incentivized to fight fraud on that site? that is why i posted the MSNBC report, because government really does not have any true incentive to fight fraud. medicare will stay in business, until it runs out of money, whether the government challenges fraud or not.
Medicare does have to answer to the taxpayers, not the stock-holders. My post, combined with this:
Quote:
Originally Posted by jojajn
This information is so false. I close relative of mine is in the FBI. His job is to find Medicare fraud. The government does have an incentive, and does investigate as well as prosecute, Medicare fraud.
Forum members, please don't mistake a post here which is a personal opinion as fact!
Here is a website for reporting any suspected Medicare fraud to the government. It was last updated in 2008.
Medicare.gov - How to Report Medicare Fraud
does show that medicare is interested in fighting fraud. I would love to know what the health ins. industry is doing re: this issue.
I would love to know what the health ins. industry is doing re: this issue.
Several things actually:
As a patient, I get letters from my insurance company asking me to review the detailed bill I get from the Hospitals, Doctors and other providers that have been involved in my treatment. They ask me to let them know of "suspicious" charges for equipment and care - and I have done so.
These insurance companies also perform audits of Doctors and Providers - to review equipment and charges - to see if things that were billed were actually delivered.
You might want to do some Internet surfing for news reports on Ins Companies that have gone after Doctors and Providers for "fraud" - and been successful.
Your implication was clearly - that Ins Co's don't do any of this. You are wrong.
As a patient, I get letters from my insurance company asking me to review the detailed bill I get from the Hospitals, Doctors and other providers that have been involved in my treatment. They ask me to let them know of "suspicious" charges for equipment and care - and I have done so.
These insurance companies also perform audits of Doctors and Providers - to review equipment and charges - to see if things that were billed were actually delivered.
You might want to do some Internet surfing for news reports on Ins Companies that have gone after Doctors and Providers for "fraud" - and been successful.
Your implication was clearly - that Ins Co's don't do any of this. You are wrong.
All these same things are done by the government to fight Medicare fraud also.
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