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This is the one area private insurance does better: reducing fraud. Medicare should require authorization for procedures/services like HMOs do instead of paying for everything and then deciding it was fraudulent.
A lot of legitimate claims aren't granted for many of the same reasons fraudulent ones are--improper paperwork, caseworker error in judgement, etc. I've seen a number floating around showing 10% of all denied insurance claims are wrongfully denied.
If the question is ten percent of insurance claims are denied wrongfully, versus 10% of Medicaid spending is fraudulent, I'd side with the fraudulent. I'd rather help people who don't need it than deny people who do.
Quote:
It isn't always fraud. Medicare has a history of going back years and applying new rules to old episodes of care and then deciding it was fraudulent. Its a way to make money. Much of Obamacare's revenues were built on the premise of recovering so much money per year. If there isn't enough true fraud, don't worry, they'll make some activities seem fraudulent, just to make the money.
That seems highly speculative. I do want to point out this ignored statement from Politifact that the OP didn't even mention.
Quote:
Originally Posted by Politifact
As Issa said, improper payments can include money paid to the wrong person or for procedures that didn't happen. But there's more to it than that. About a third of Medicare's improper payments are the result of a claim not having enough, or proper, documentation. Upon further investigation, many of those claims are ultimately deemed proper. One example is a payment based on a claim by a doctor who submits forms that are illegible.
Also, not all improper claims can be completely recouped. For example, say a surgeon was paid $10,000 for an inpatient procedure when Medicare only reimburses for an outpatient procedure that costs $5,000. The government wouldn't recoup the full $10,000, just the $5,000.
In other words, the government wouldn't end up with $125 billion even if all improper payments were eliminated for all those services, including Medicare.
I'm going to rundown that 10% number of insurance claims in the next couple of days and verify it's accuracy. I've got an early ass morning the next two days, probably won't make it tonight.
Oh look... an audit of Medicare ended up costing $102M and uncovered $20M in overpayments. In other words, it cost more than FIVE TIMES as much as it saved. That is some money well spent.
The total amount of Medicare fraud is difficult to measure accurately, because we know that not all fraud is detected and not all of the claims that look suspicious are reported or investigated. According to the Office of Management and Budget, Medicare "improper payments" in Medicare came to $47.9 billion ($34.3 billion in Medicare fee-for-service and $13.6 billion in Medicare Advantage). The Congressional Budget Office estimates that total Medicare spending was $528 billion in 2010.
Medicare fraud of $47B is almost 10% of the total Medicare budget, and no one is all that concerned about it. We all remember ENRON, but we have even more fraud and waste from Medicare, and who knows how much more between Social Security and Medicare.
Now we have another government program, and more fraud and abuse.
You'd think the debt crisis would result in crack downs on government waste and fraud. But as jobless claims increase in this jobless recovery, abuses in unemployment insurance have hit record levels. States paid out a whopping $16.5 billion to ineligible individuals last year. During the 12 months from April 2010 to March 2011, overpayments jumped again to 11.6 percent--more than $1 for every $9 paid out, a 1.6 percent increase over the historical average last decade.
I think we need to seriously rethink these big government spending programs, either that or we need to demand some real accountability.
There are two schools of thought:
One school is that there are a few fraudsters, so let's chuck the whole program and hurt many people because of the actions of a few.
The other is "punish the ones commiting fraud" and keep the programs that people need desperately. rational people attend this school.
If you think you'll get a groundswell of support for cancelling major programs because there is fraud, well buddy, I have news for hearts and flowers land...the world is full of corruption.
This thread needs to stay at the top of the forum. Liberals need to be forced into admitting that their beloved Big Government can't get any of it's benevolent ideas off the ground without acquiescing to mega-amounts to fraud, waste, and abuse. It's almost as if Democrats and liberals consider massive FWAB to be the cost of doing business. They should be held accountable for their failed ideology.
Clearly you've read through the entire thread and have studied the discussion at hand, and aren't simply jumping into the middle of an argument with zero capacity to defend it, right?
Yes, in fact I have read the entire thread and I see not one single liberal questioning their benevolent government's ability to be good stewards of taxpayer dollars. Perhaps you can demonstrate your capacity to explain this phenomenon of ignorance by the liberal left?
When they were first touting this nonsense of obamacare they said they were going to pay for it by cracking down on fraud. I guess they haven't started yet.
This thread needs to stay at the top of the forum. Liberals need to be forced into admitting that their beloved Big Government can't get any of it's benevolent ideas off the ground without acquiescing to mega-amounts to fraud, waste, and abuse. It's almost as if Democrats and liberals consider massive FWAB to be the cost of doing business. They should be held accountable for their failed ideology.
I don't think liberals can admit that their beloved big all-powerful government has any flaws. They believe in government, they put all their faith in Big Government, they trust it, they adore it and worship it. Liberals think it's silly to believe in a God, but they believe and trust in Government completely.
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