Tuesday, September 13, 2011

On Fraud, Abuse and Medicare

As Bob pointed out this summer, "fraud and abuse" represents a pretty hefty chunk of Medicare's budget. Of course, we'd all like to see less of both, but that agency's own culture of incompetence makes it darned unlikely:

"It started when Richard West went for some dental work and was told his Medicaid benefits had somehow maxed out ... He called various government hotlines but got no help."

What Mr West is referring to in the first place is something generally not known by we lowly citizens: that Medicare has limits on certain benefits, and that some of his had been used up without his knowledge, or consent:

"After checking his own medical records [he] discovered the company providing him with nursing care appeared to have overbilled Medicaid for hundreds of hours for people who were never there."

Now, multiply that by the almost 50 million people enrolled in Medicare, and the numbers boggle the mind. Certainly, most providers aren't engaging in fraud, but how many have to be to generate huge dollars, and lots of folks with exhausted benefits?

The story doesn't end there, of course:

"The case involved the U.S. Attorney’s office, the FBI, the Department of Veterans Affairs, the Department of Health and Human Services, and Medicaid Fraud Control Units in New Jersey, Virginia and Massachusetts."

All vying for a slice of the ($150 million) pie and bragging rights.

Even that, though, fails to illustrate the magnitude of the problem:

"One of West’s nurses ... had been told she would be paid $27 an hour. When she received her paycheck, it showed her hourly rate was only $21 an hour ... the manager of the office showed her payroll stubs indicating that she was being paid for administering to a patient she had never seen ... If you want to make the money, this is how we do it"


Mind you, this went on for almost a decade, and would still be draining our tax dollars were it not for a feisty, disabled Vietnam vet.

So: Thank you for your service to your country, Mr West. Twice.
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