We know that insurance fraud costs us all money, but we often fail to consider other harm to consumers. Sure, the financial impact is notorious…We all pay for health insurance fraud because the government and insurance company payers PASS THOSE COSTS onto consumers.
With billions of dollars at stake you would think that Obamacare would have taken steps to make pursuing fraud, tracking down the perpetrators and punishing them extremely harshly a priority instead of a non-issue.
When it comes to health insurance fraud, Obamacare is a dismal failure because it not only forces people to purchase health insurance products that keep getting more and more expensive while providing less and less coverage for needed medical services, but it actually discourages health insurance companies from going after fraudulent claims as part of the 80-20 rule that requires insurers to spend no more than 20 percent of their earnings on administrative costs and profits of which going after fraud is considered, making it less likely to be pursued than if it had been included as part of the 80 percent insurers can spend on medical claims and quality improvement plans.
The government itself as a payer has fraud as such a low priority under Obamacare that after a government investigation found that Obamacare payouts and enrollment were fraught with fraud, a CMS worker stated: “CMS admits that its contractors aren’t required to detect fraud…” (http://news.investors.com/ibd-editorials-obama-care/071615-762040-investigators-kept-bogus-obamacare-accounts-going-for-more-than-a-year.htm).
But fraud has other consequences as illustrated in the LA TIMES in an article by Richard Winton and Matt Hamilton, 9/15/2015, “Patients scarred, insurance firms duped in massive scam, L.A. County prosecutors say,” http://www.latimes.com/local/lanow/la-me-ln-indictment-doctor-lawyer-massive-medical-fraud-20150915-story.html.
Lives are ruined by our system’s laziness in going after fraudulent providers opting instead to support policies that pass the costs of that fraud onto consumer taxpayers and patients.
You can read the details of “Dr.” Munir Uwaydah’s stark example of a system that doesn’t work at the cite above.
For a consumer website like this, the issue is needed change to Obamacare INCLUDING rewarding health insurers and consumers monetarily for the discovery and reporting of fraud, speeding up the process for the prosecution of fraud, and the automatic suspension of medical licenses and the ability to have a practice where allegations of fraud that jeopardized patient health are under investigation.
If you read the article you’ll see the need for these changes.
Facts: More than $150 million was billed to insurance companies for “…medical evaluations that never occurred,…evaluations that never occurred,…falsified…records to justify surgeries, some of which were unnecessary.”
There are also allegations of “…illegally referred patients to Uwaydah’s clinics in exchange for up to $10,000 a month,” and surgeries “…performed by a physician’s assistant.”
The investigation has been going on for FIVE YEARS.
In 2010 Uwaydah had his license suspended for two years when a Medical Board determined he had committed “gross negligence…in 2005 [when] he allowed his physician's assistant to conduct procedures while patients were under anesthesia.” His license wasn’t canceled until 2013. http://www.latimes.com/local/lanow/la-me-ln-indictment-doctor-lawyer-massive-medical-fraud-20150915-story.html.
Obamacare’s UNWILLINGNESS to create the obligation of both governmental and private insurers to actively pursue fraud, place strict timelines on how fast such investigations must proceed, demand that Medical Board’s act on allegations that involve patient safety within a REASONABLE time are all easily addressed in a system that considers consumers. Obamacare is not such a system.
