The federal investigation into the relationship between Democratic donor Dr. Salomon Melgen and Sen. Bob Menendez (D., N.J.) has exposed the rampant culture of Medicare and Medicaid fraud, which by some estimates cost taxpayers as much as $98 billion in fiscal year 2011. The raid by the FBI and the Department of Health and Human Services (HHS) of Melgen’s eye center in Florida spanned two days in late January. The involvement of HHS indicated “the search-and-seizure raid has ties to a possible Medicare fraud inquiry,” the Miami Herald reported. The FBI reportedly went in after authorities spotted
However, the GAO has long identified Medicare as a high-risk program, and it has issued frequent reports on identifying fraud and finding ways to help combat it.
Can you find two clues in the above sentence which prove that government cannot do anything well?
“Moving from responding once fraud has already occurred to preventing it from occurring in the first place is key to ensuring that federal funds are used efficiently and for their intended purposes,” Kathleen King, the director of health care for the GAO, said...
Again, the above is a case of a lot of words, reports and committees being actively participating in getting nothing done until so much damage has been done that the POTUS has to lie about how much really got done.
Our government is broken in too many ways to fix under the present way of doing things. Establishment Republicans and ALL Democrats must go. By any means necessary.
Private insurers go to great pains to ensure that the patient is indeed insured, that injuries didn´t occur at work place or in an automobile which would be subject to other insurance, and that the doctor is real and provided valid medical service. Medicare does none of these things at least for the first several bills. We taxpayers can´t allow fraud to consume $98 billion a year.
Ms. Byrd provides an accurate view as to how health care fraud investigations generally happen and she accurately notes that the availability of a "qui tam" is often a key factor in deciding to proceed with an investigation. Generally speaking, attorneys working in DOJ´s civil division figure they have only so many years to "make their bones" before leaving for private employment and prefer cases that will provide the largest recoveries in the shortest possible time.
The GAO´s claim that, in FY 2011, the government recovered $4.2 billion is, most certainly, an inflated figure. It is a simple manipulation to conflate medicare fraud dollars that are actually "recovered" by investigators, with volumes of fraud the government claims it "stopped" or "prevented." These latter claims are designed to make the government look good and involve numbers the bureaucrats pull out of their...er...hats.
Just assuming for a minute the $4.2 billion is correct, I´d like to know how much it cost to collect. How about a "net" figure? I´d also be interested to see the budgets of the departments involved in investigating fraud. Just a wild guess here but I imagine we´re not getting much bang for the buck.
The article mentions shortage of staff as the reason that much of the fraud goes undetected. Why not transfer the tax auditors hired to collect Obamacare taxes over to the fraud side of the equation. This would be more productive work for them.
Reply 12 - Posted by:
Ida Lou Pino, 2/20/2013 9:24:47 AM (No. 9186484)
One good thing about this Menendez scandal - -
- - it´s finally bringing prominence to men with pumpkin heads.
Just about every woman I know swoons at the sight of a man with a pumpkin-shaped head. There´s nothing sexier - - but unfortunately it´s been sadly overlooked. Now - - at last - - men with pumpkin heads are getting their well-deserved accolades.
If nothing else - - thank you Sen. Bob for finally righting this gnawing social injustice.
As long as the tax system can be used for coercion, punishment, reward, etc. we are not the free nation that the Constitution promised and our patriots died for. If we had a tax system that did not allow Congress to dictate to us our very lives, liberty and what we can pursue as happiness then we would be a freedom filled nation again.
This administration is forever touting the low administrative costs for the Medicare/Medicaid programs and comparing them to the much higher administrative costs in the private insurance industry. Well, you´re not going to find private insurance companies dealing with billions upon billions of dollars of fraud after the fact. No, they employ experts who routinely detect attempted fraud before claims are paid. Dealing with this problem is not easy and it´s not cheap, but it is one more thing government is not good at.
Sorry. The attempts last year to find fraud in Medicare caused my first year with so much junk in my reports that I quit keeping track. It also caused my physician hours of work to correct charges which were within my deductible and thus of no effect on fraud (and I never got billed by them for miniscule changes which were in the physicians´s favor).
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