Is there nothing we could have done to prevent the prevalence of Medicare/Medicaid fraud that’s cannibalized the funding available for health insurance programs and payments coming from the government?
For too many years, we’ve bought into the red herring, the distraction that incorrectly directed the “blame” for higher insurance and healthcare costs on patients…Go after patients, the sickest, the ones who make bad life choices and under Affordable Care, those who have dared to age and let private insurers get more money to meet rising costs.
In the government insurance plans, reward physicians for implementing cost-saving changes that “manage” (reduce) costs through a variety of means in terms of how patients are deemed eligible for and obtain treatment AND beginning in 2020, if the costs of Medicare are still deemed too high for a given year, convene the Independent Payment Advisory Board to determine where to make cuts.
Citizens look at each other and decide that they can save money if one older person is charged more for health insurance, one smoker, one person who refuses to lose weight. It’s fostered an industry of “wellness” where corporate nannies counsel, harangue and “manage” patients. Yet costs go on and the ONLY recommendation for addressing those costs that has real teeth has been the one saying CUT Medicare and limit eligibility and “manage” the sick and their treatment some more.
Red herring. Going after FRAUD could redirect the system more effectively than managing the chemotherapy options available to someone based on age. It’s time to pay attention to fraud. It’s time for the government to consider privatizing investigations into fraud by contracting out the legal investigations and prosecutions that they continually claim they don’t have the manpower to do. Contract it out. Most would agree there are enough law firms in the world to take it on.
While Medicare fraud cases have been stepped up since the Medicare Fraud Strike Force began in 2007, still lack of manpower is claimed as one of the reasons that fraud in amounts that are loosely estimated to be upwards of $60 billion a year (based on 2010 guesstimates) persist.
This week, DaVita, a corporate giant that is a dialysis company is accused of yet more Medicare/Medicaid fraud and is scheduled for trial next year. It’s not the first time. As reported in the “Denver Post,” last year, DaVita has been charged with fraud before and in addition to open cases received a verdict in its favor returning Medicare/Medicaid funds. DaVita is asserting these past accusations and outcomes as part of a defense it seems, claiming it’s been investigated and cleared on some occasions while acknowledging that it settled another case for $55 million this year, 2012.
While overshadowed by election campaigns, this October, October 2012, 91 medical professionals including nurses and doctors were charged with Medicare fraud totaling $430 million. In May of 2012, $452 worth of fraud was charged against 107 healthcare or health services providers.
Why the lack of attention from the population (in addition to buying into that it’s other citizens’ “fault”)? Well, there’s been a theory put forth by those advocating the decimation of government programs that those insured by Medicare/Medicaid don’t have enough skin in the game, they don’t pay for it so they don’t watch how the money’s spent. Give the devil his due, it’s partially true. When insurance covers the costs, patients who might glance at their statements only LOOK at their statements when there’s a balance owed. That is part of it.
Another reason for consumer inattention? Well, quite frankly it doesn’t pay. What’s in it for them besides a lot of time writing a complaint or filing a report? There is a website that people can use to report suspected fraud in Medicare at www.stopmedicarefraud.gov but honestly, the reward only goes up to a MAXIMUM of $1,000. Hardly incentive to spend hundreds of hours going through statements, filing reports and by the way having to find a new healthcare provider.
Who can make real money from reporting Medicare fraud? Employees and professionals involved in an organization, the so-called “whistleblowers,” they’re eligible for 25 percent of money recovered by government with a guarantee of at least 15 percent of the money recovered by the government.
The good news is that we’re halfway there because we’re comfortable pointing the finger at someone, even one another. Having adopted and institutionalized the concept that someone else’s lifestyle or physical condition is THE reason that we’re paying more for healthcare, it should be easy to redirect that blame at culprits accounting for upwards of $60 billion a year in wrongfully obtained funds.
