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“The Millers devised a scheme to defraud Missouri taxpayers by overbilling for Medicaid services or by billing for services never delivered at all,” Koster said.
I wonder how much fraud is being commited involving these two programs?
Fraud is rampant in the programs and waste is significant. Medicare will pay rent for wheelchairs and hospital beds that far exceed the cost of an outright purchase of equipment. The Durable Medical Equipment suppliers are doing a happy dance and the taxpayers are getting ripped off.
I think this is the one weakness of a govt plan compared to a private plan. THey always seem to be too slow to catch fraud.
NY is starting to really go after medicaid fraud, and its good to see. THe next step should be tying IRS/local tax/ and S chip programs together to see if the guy living in a $500k house with $20k property taxes is really making the claimed 25k a year in his all cash business.
Probably about the same as corporate fraud inside insurance companies.
Private insurers claim fraud costs them 100 billion dollars a year. Of course they don't care all that much, they just jack up the premiums 20 percent a year, and write off the fraud.
Private insurers claim fraud costs them 100 billion dollars a year. Of course they don't care all that much, they just jack up the premiums 20 percent a year, and write off the fraud.
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?
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?
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.
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)
I should probably stop right there, but to defend the holy "private" insurance companies is insane.
Private insurers only include "high quality" providers in their networks? Gimme a break! Quality is not one of the concerns of pvt insurers, and it's difficult to measure, anyway. It's all about the money.
Most private insurance does not cover full costs, either. The price the insurance pays is less than the price the provider charges, in almost every case. Doctors enter into these agreements b/c knowing they will get paid for service is the positive side of not getting the full cost.
Quite alot of information at the Department of Health and Human Services, Office of Inspector General website. Also see the various state agencies and the Centers for Medicare and Medicaid website. Then there's others such as watch dog groups, GAO, etc.
I wonder how much fraud is being commited involving these two programs?
What's sad is that Medicaid/Medicare program will take the blame for this.
THIS is NOT the fault of the program. THIS is the fault of the SCUMBAGS who DEFRAUDED Medicaid/Medicare.
THEY are the criminals.THEY are the ones to blame.
Do you not think that insurance fraud within private companies exist as well.. I bet you it does! Difference is we don't hear about it because it doesn't , on the surface "affect" us.. but believe me it does.
BTW.. this is also done in the car insurance industry (fraud).
There are ALWAYS scumbags who will manipulate a system to defraud it.. no matter what it is... it doesn't make it the fault of the actual program or program runner (in this case the government)..b ut the fault of the individual who is the criminal.
That would be like saying a jewelry store owner is to blame for being robbed because he had a jewelry store in which to rob!
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