Medicare fraud

M.Blackmore mblackmore at oxlug.org
Tue Jan 25 02:54:52 PST 2000


Whilst undoubtedly creaming off does occur, it is worth reflecting on the fact that the British NHS (National Health Service) provides better health care to all the population at a cost level approaching 50% per head less than the privatised US system. The nature of fraud and creaming off is somewhat different - it mostly occurs in the provision BY PRIVATE COMPANIES of equipment and drugs at inflated prices. Because services in the NHS are free at the point of delivery and most Drs work for the NHS under salary or in group practices for general practive, it is very hard to make fraudulent claims for the patients treated. Undoubtedly false claims do exist for the various private medical schemes like BUPA who have been trying to make inroads into British health care, where a claim for payment to the insurance company must be made to recoup the costs of treatment. In short a private health system MUST be more open to fraud and abuse.

The Europeans have more private delivery than the UK with the NHS, although it would be wrong to say it is a "half way house" between the US and UK, I think the W.European countries are more National Health in character than US privatised health. But in any system where applications for payment to the State health authorities are made by medical practitioners for treatment carried out there will exist the opportunity and temptation for fraud.

In short, I would wager that the UK NHS system is less prone to treatment-claim fraud and hence less wasteful than any other system around. What we need to do is get hold of the rip offs by supplying contractors and drug companies and outsourced test facilities (the latter have grown a lot in recent years). And of course the eternal struggle to contain bureacratic waste.

Some other thoughts: True the US system delivers the *top* range of high tech medicine at a superior level to the British, who are poorly equipped with medical machinery compared to the private US hospitals, and are restricted by drug lists to a moderate extent.

But of course in the US you have to pay for that "quality" and that depends upon how fat your purse is... and of course some 50% of the population are in no position to do so adequately (and something like 20% have no health care at all apart from charity).

Having had the experience of growing up in poverty in N.America and losing an eye due to inability of parents to pay for health care, and a baby sister ditto, and a sister who's (quite realistic) ambitions to be a dancer were wrecked by an arm injury that couldn't be treated properly due to lack of shekels (arm? for a dancer You ask? Well, if you can't move one arm fully and gracefully due to joint damage that could have been put right, it don't look so good, and end of aspirations) I have pretty strong views about the NHS having now lived in the UK for 30 years. Use of the word "liars, thieves and degenerate scum" and the appellation "uncivilised country" to the USA and the dominant health care private organisations in their resistance to universal competent health care for all, are those words which I feel able to write in a public forum. I can supply many more in private which express my views more succinctly >;->

How long before the American people realise that theirs is simply not a civilised nation, but a collection of competing barbarities?

Although social-democratic health care systems in the UK and Europe are open to justified criticism - the cost of any large organisation and consequent inevitable bureaucracy has got to be that of eternal vigilance, would that it were otherwise but it ain't and never will be - the use of "fraud" and "rip off" as a subtext for discrediting the public commonwealth system and replacement by the "efficient" private sector (conveniently forgetting the implications of what "for profit" means in social divisive terms) is itself a fraud and a self-serving thieving lie by moneygrubbing scum who have disqualified themselves from consideration as civilised persons and even human beings <rant rante>(come the revolution the first against the wall, eh <revolutionary grin>).

But, passionate hyperbole aside, as statistics I have seen reported at times over the years show show, the state health systems are significantly cheaper on delivery than profit driven services, particularly in the mass delivery of basic medical services which is what the majority of people need most of the time. The British NHS is I believe the cheapest per capita of any developed nation, even when adjusted for service quality levels.

<Goes off to think up exquisite and terrifically long-lasting tortures to death for private health company promoters>

In article <388D3193.4D2A1A5B at lafn.org>, ap888 at lafn.org (Marta Russell) wrote:


> FYI --
> I wonder if the Western European democratic
> socialist countries experience such a high level
> of public health care rip offs?
>
> Marta
>
> PRESIDENT CLINTON RELEASES REPORT ON SUCCESS OF
> FIGHT AGAINST MEDICARE
> FRAUD, ANNOUNCES NEW ANTI-FRAUD
> FUNDING
>
> January 22, 2000
>
> In his radio address today, President Clinton will
> highlight the success of
> the Administration's efforts to combat Medicare
> fraud and will announce a
> new initiative to fortify those efforts. In the
> wake of this week's
> landmark recovery of over $480 million by the
> Justice Department in the
> criminal fraud case against a national Medicare
> provider, the White House
> today will release two reports documenting the
> success of the
> Administration's current anti-fraud efforts. The
> reports find that because
> of the Administration's work: (1) nearly $500
> million was returned to the
> federal government during FY 1999, a 65 percent
> increase over the previous
> year, and (2) the inappropriate payment of
> approximately $5.3 billion in
> claims was prevented over the past year. The
> President today will also
> unveil a new $48 million investmen to ensure a
> swift and coordinated
> response to fraud, waste or abuse by Medicare
> contractors.
>
> MAJOR VICTORY THIS WEEK AGAINST FRAUDULENT
> MEDICARE PROVIDER. On
> Wednesday, the Department of Justice, together
> with the Department of
> Health and Human Services, announced that it had
> achieved a $486 million
> settlement with a national health provider that
> had been bilking the
> Medicare program. The company at fault had used
> Medicare and other
> government health insurance programs to pay for
> hundreds of needless tests
> and unnecessary nutritional therapies for
> patients. In addition, company
> customers received financial rewards, such as
> trips to Canada and lavish
> dinners, for sending patients to certain lab
> facilities for tests -- a
> violation of anti-kickback statutes. The total
> settlement amount will be
> returned to the Federal government over two years.
>
> NEW REPORTS DOCUMENT SUCCESS OF ADMINISTRATION'S
> ANTI-FRAUD EFFORTS.
> Today, President Clinton will release a report,
> prepared jointly by the
> Departments of HHS and Justice, that documents the
> success of the
> Administration's current anti-fraud effort. He
> also will release a new
> report by HCFA documenting how program integrity
> activities have prevented
> inappropriate payments. Major findings of the
> reports include:
>
> Anti-fraud activities returned almost $500 million
> to the federal
> government in 1999. In 1999, the federal
> government collected $490 million
> as a result of health care fraud prosecutions. Of
> that amount, almost $369
> million -- more than 75 percent of the total --
> was returned to the
> Medicare trust fund.
>
> Cases are being closed successfully. The number
> of cases filed and
> defendants charged in criminal health care fraud
> cases during 1999
> increased 16 percent from the previous year, and
> the number of defendants
> convicted during that time period increased by 21
> percent.
>
> Fraud prevention and program integrity activities
> are working. HCFA
> announced today that program integrity efforts
> prevented an estimated $5.3
> billion from being inappropriately paid to
> providers in the last part of
> 1998 and the first part of 1999. In addition, a
> review of Medicare payment
> error rates showed a 45 percent drop in improper
> fee-for-service payments,
> totaling $10.6 billion over the last two years.
>
> Fraudulent providers are being locked out of the
> system. During 1999, HHS
> barred 2,976 individuals and companies from
> participating in Medicare,
> Medicaid, or other federal health programs. These
> providers had been
> convicted of health care offenses (such as patient
> neglect and abuse,
> kickback offenses and fraudulent billing), or had
> lost a license to
> practice, or had committed some other form of
> professional misconduct.
>
> Beneficiaries are protecting Medicare against
> fraud. In February of 1999,
> the Administration joined with the AARP to launch
> an initiative called "Who
> Pays? You Pay" to educate Medicare beneficiaries
> about how to identify and
> prevent Medicare fraud. Since the campaign
> kick-off, there have been over
> 300,000 calls to the HHS Hotline (1-800-HHS-TIPS),
> up from 76,000 calls in
> 1998.
>
> NEW BUDGET INITIATIVE TO FORTIFY EFFORTS AGAINST
> FRAUD BY MEDICARE
> CONTRACTORS. Although these reports demonstrate
> that the Administration's
> fraud, waste, and abuse prevention efforts are
> more effective than ever,
> more still needs to be done. While Medicare
> contractors serve as HCFA's
> front line of defense against fraud, waste, and
> abuse, too many contractors
> do not protect the program as they are required
> to, and this results in
> payment of billions in inappropriate claims. To
> address this problem,
> President Clinton today will unveil a new
> initiative to fight fraud, waste,
> and abuse in the Medicare program as part of his
> FY2001 budget, which
> includes new legislative authority and invests $48
> million to:
>
> Improve the consistency and accuracy of Medicare
> payments. This new
> initiative will create a team of over 100
> financial management specialists,
> one in the office of every Medicare contractor
> nationwide. These
> "fraud-fighters" will ensure a swift and
> coordinated response to suspected
> instances of fraud.
>
> Implement new financial management computer
> systems. The FY 2001 budget
> will invest new funds to develop financial
> management computer systems to
> accurately track payments and prevent claims
> processors and auditors from
> defrauding the program.
>
> Ensure that Medicare receives the best value for
> its investments. The
> budget includes new authority for HCFA to bid
> competitively for contracting
> services, to ensure that the most qualified
> entity, with the most
> experience auditing and evaluating financial
> management systems, is hired
> to manage the flow of Medicare claims and prevent
> fraud. The budget will
> also include a new competitive pricing initiative
> designed to give Medicare
> more ability to use market-oriented purchasing
> techniques to buy services.
>
> LONGSTANDING COMMITMENT TO FIGHTING FRAUD, WASTE,
> AND ABUSE. The new steps
> the President will take today build on the
> Clinton-Gore Administration's
> longstanding commitment to crack down on fraud,
> waste, and abuse. Since
> 1993, the Administration's efforts have saved
> taxpayers more than $50
> billion, with the number of individuals convicted
> of health care fraud
> increasing by more than 410 percent. The
> Administration has assigned more
> federal prosecutors and FBI agents to fight health
> care fraud than ever
> before. Since the passage of HIPAA -- which
> created a stable funding
> source for anti-fraud efforts -- nearly $1.6
> billion has been returned to
> the Medicare Trust Fund.
>
>
>
> ========================================
>
>
> THE WHITE HOUSE
> Saturday, January 22, 2000
>
>
>



More information about the lbo-talk mailing list