Yukishiro1
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When people talk about medicare fraud, what do they mean?
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Are they talking about doctors billing for services not actually performed? I have a hard time thinking of anything else off the top of my head.
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Tych2
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When people talk about medicare fraud, what do they mean?
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That plus also probably people faking injuries. Bad backs etc.
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Corky_Aloof
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When people talk about medicare fraud, what do they mean?
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Yes, both. It is a huge HUGE problem.
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Seething199
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When people talk about medicare fraud, what do they mean?
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doctors lose their license and potentially go to jail for billing for a procedure they didn't perform. the more realistic problem is doing a bunch of procedures that barely qualify as necessary.
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Yukishiro1
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When people talk about medicare fraud, what do they mean?
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Tych2 posted:
That plus also probably people faking injuries. Bad backs etc.
What's the incentive? The person doesn't get any money from that from medicare.
That sounds like disability fraud, not medicare fraud.
Or you mean they're faking for some other reason - probably disability - and medicare ends up paying for treatment for a fake injury? But how many people who get medicare are still working and have an incentive to try to pretend to be disabled?
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Ptilk
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When people talk about medicare fraud, what do they mean?
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A lot of fraud in medicare is in the form of prescribing devices or services that are not actually required, then profiting from providing those devices or services.
Medical devices such as scooters, home oxygen services, physical therapy, even tests that are of no medical benefit, like checking PSA levels of a 97 year old man dying of a gunshot wound.
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Tych2
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When people talk about medicare fraud, what do they mean?
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Yukishiro1 posted:
Tych2 posted:
That plus also probably people faking injuries. Bad backs etc.
What's the incentive? The person doesn't get any money from that from medicare.
That sounds like disability fraud, not medicare fraud.
Its the first step in disability fraud. 
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Yukishiro1
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When people talk about medicare fraud, what do they mean?
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Seething199 posted:
doctors lose their license and potentially go to jail for billing for a procedure they didn't perform. the more realistic problem is doing a bunch of procedures that barely qualify as necessary.
That's sorta what I am thinking too. But that's not really fraud. And the same people who cry about medicare fraud also cry about death panels - but that's exactly what you'd need to stop that sort of fraud, isn't it? Someone telling the doctor "no you can't do that test because we don't think you need to."
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Seething199
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When people talk about medicare fraud, what do they mean?
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it's a thin line. there are definitely doctors that milk the system. but there are also doctors that practice defensive medicine to avoid getting sued. every ignorant clod comes to the doctor these days expecting an MRI, a CT, and god knows what else because they watch House. if you don't do all of this unnecessary crap for them and there's a bad outcome, you get sued whether it would have helped or not.
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Clackdor
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When people talk about medicare fraud, what do they mean?
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http://www.medicare.gov/navigation/help-and-support/fraud-and-abuse/fraud-overview.aspx?AspxAutoDetectCookieSupport=1
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Taliesihne
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When people talk about medicare fraud, what do they mean?
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I always get the sense that person claiming fraud doesn't know specifically, but is sure it involves african americans.
Somehow.
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Yukishiro1
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When people talk about medicare fraud, what do they mean?
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Tych2 posted:
[quote=Yukishiro1]Its the first step in disability fraud.
But like I said, that doesn't really make much sense. SSDI cuts out when you become eligible for SS. Medicare is for 65+. There is only a 2ish year window where you are eligible for medicare but not SS.
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Tych2
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When people talk about medicare fraud, what do they mean?
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Taliesihne posted:
I always get the sense that person claiming fraud doesn't know specifically, but is sure it involves african americans.
Somehow.
[ Someone is always keeping the brown man down!
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Yukishiro1
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When people talk about medicare fraud, what do they mean?
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Clackdor posted:
http://www.medicare.gov/navigation/help-and-support/fraud-and-abuse/fraud-overview.aspx?AspxAutoDetectCookieSupport=1
I didn't ask what Medicare thought Medicare fraud was. This was prompted by Bjovald's rant in the other thread about medicare fraud. I am curious what people think that means in practice, or whether they even think about such things at all.
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AzureTyger
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When people talk about medicare fraud, what do they mean?
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Most people confuse abuse with fraud. Medicare claims aren't as tightly monitored as private insurance.
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cherrim
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When people talk about medicare fraud, what do they mean?
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Yukishiro1 posted:
Are they talking about doctors billing for services not actually performed?
Yes.
If they are talking about anything else, they are confused.
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Bowlartz
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When people talk about medicare fraud, what do they mean?
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"That's sorta what I am thinking too. But that's not really fraud. And the same people who cry about medicare fraud also cry about death panels -"
Medicare fraud is exactly what is sounds like, theft of money.
It can be anything from doctors over billing intentionally, prescription fraud to the biggest problem medicare faces which is criminal organizations and people who simply get approved into the system and bill for NO service provided what so ever. They simply set up a billing "address" which is often a one room office somewhere in Florida or somewhere down south (this is the biggest region in the country for fraud) and simply either con or steal personal information from Medicare enrollees and then bill millions of dollars which the government blindly pays.
A popular piece of the fraud is for medical devices (oxygen, wheel chairs, prosthetic limbs etc). They make millions, close the office and then open a new one somewhere else.
The system needs a massive, massive overhaul including a modern computer system set up to detect suspect fraud.
Fraud to medicare is a huge problem nearing 70 billion per year. The system is so massive, people have found places to easily hide.
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IMHO
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When people talk about medicare fraud, what do they mean?
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Ptilk posted:
A lot of fraud in medicare is in the form of prescribing devices or services that are not actually required, then profiting from providing those devices or services.
Medical devices such as scooters, home oxygen services, physical therapy, even tests that are of no medical benefit, like checking PSA levels of a 97 year old man dying of a gunshot wound.
This
90% of the places you see while driving around that has 'medical supplies' on the store front is probably fraudulent. 60 minutes did a piece on it a while back. All you need is an old persons SSN and your off to the races sending in invoices and collecting the monies. It's painfully easy and so abused because the staff that investigates this type of fraud is terrible under staffed and funded. It an excellent way to make money.
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Yukishiro1
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When people talk about medicare fraud, what do they mean?
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Bowlartz posted:
Fraud to medicare is a huge problem nearing 70 billion per year.
Are you saying there is 70 billion dollars a year in claims for services never actually provided?
Because I don't think that's what that number is.
The 70 billion number is an estimate of the amount of unnessecary crap doctors do and then bill medicare for. The only way to attack that is death panels. You need the gubmint looking at bills and saying "nope, granny didn't really need those tests," which quickly becomes "nope, granny doesn't really need those tests" because doctors arn't stupid and arn't going to do tests and then bill for them later if they're not sure they'll be approved.
No doubt there is a substantial amount of straight up fraud. But that number is not for pure fraud.
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IMHO
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When people talk about medicare fraud, what do they mean?
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Here Yuki watch this. It's the 60 Minutes segment. It's about 7 minutes.
http://www.youtube.com/watch?v=GUY_01n1XWQ
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cherrim
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When people talk about medicare fraud, what do they mean?
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There is a lot of fraud out there. I do not know the numbers and $70b sounds high, but it's pretty rampant.
A chiropractor came to give a talk to our class. He was trying to put together a defense for a pending trial in which he was being charged with over $3mil in medicare fraud. He was billing for all kinds of services, but most of his fraud consisted in billing for an hour-long session when he only spent 15 minutes with the patient, or billing for a manipulation technique (similarly to medical procedures this gets the practitioner more money) when he really only did a basic exam. Stuff like that.
Eventually the feds caught up to him and now he is going around telling kids not to do what he did. This was just one guy who over the course of 5-6 years took $3m from the taxpayer.
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Yukishiro1
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When people talk about medicare fraud, what do they mean?
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Like I said, I don't doubt there's lots of fraud.
But 70 billion would mean 15% of medicare expenditures were for stuff that never even happened. That is obviously not credible.
The 70 billion number is a catch all for fraud, waste and abuse. I would be shocked if straight-up fraud is more than maybe 10% of that number. 7 billion is a LOT of straight-up fraud.
edit: http://www.gao.gov/products/GAO-11-409T
This is where the number comes from and like I said it is a catch-all for fraud, waste and abuse. I will check if they break it down.
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Groucho48
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When people talk about medicare fraud, what do they mean?
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Well, herte's hgow the Republican Governor of Florida, Rick Scott, company did it...
From Wiki...
On March 19, 1997, investigators from the FBI, the Internal Revenue Service and the Department of Health and Human Services served search warrants at Columbia/HCA facilities in El Paso and on dozens of doctors with suspected ties to the company.[20]
Following the raids, the Columbia/HCA board of directors forced Scott to resign as Chairman and CEO.[21] He was paid $9.88 million in a settlement. He also left owning 10 million shares of stock worth over $350 million.[22][23][24]
In 1999, Columbia/HCA changed its name back to HCA, Inc.
In settlements reached in 2000 and 2002, Columbia/HCA pled guilty to 14 felonies and agreed to a $600+ million fine in the largest fraud settlement in US history. Columbia/HCA admitted systematically overcharging the government by claiming marketing costs as reimbursable, by striking illegal deals with home care agencies, and by filing false data about use of hospital space. They also admitted fraudulently billing Medicare and other health programs by inflating the seriousness of diagnoses and to giving doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA. They filed false cost reports, fraudulently billing Medicare for home health care workers, and paid kickbacks in the sale of home health agencies and to doctors to refer patients. In addition, they gave doctors "loans" never intending to be repaid, free rent, free office furniture, and free drugs from hospital pharmacies.[4][5][6][7][8]
In late 2002, HCA agreed to pay the U.S. government $631 million, plus interest, and pay $17.5 million to state Medicaid agencies, in addition to $250 million paid up to that point to resolve outstanding Medicare expense claims.[25] In all, civil law suits cost HCA more than $2 billion to settle, by far the largest fraud settlement in US history.[26]
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GrilledCheez
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When people talk about medicare fraud, what do they mean?
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I know a lot about this. I can't say too much. Suffice it to say that every type of fraud you can imagine. Fake doctors. Fake patients. Real patients with fake procedures for fake doctors. Every type of fraud you can imagine is perpetrated by professional defrauders who make millions upon millions of dollars each year.
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eodoll
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When people talk about medicare fraud, what do they mean?
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Wasnt thre a big medicare fraud bust of some russian mafia n LA? They had setup fake doctor offices and were billing medicare for all kinds of services.
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GrilledCheez
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When people talk about medicare fraud, what do they mean?
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The number Yuki mentioned at the top is completely legit. It may even be higher than that. You guys would be amazed if you saw enforcement/audit efforts on fraudulent medicare claims. AMAZED.
And yes it is absolutely done by professional groups. Yuki assumes that waste and overbilling or over treatment are higher than actual fraud, because he believes there is a layer of competence on fraud enforcement that isn't there. it is quite literally super easy to make millions.
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imaloon1
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When people talk about medicare fraud, what do they mean?
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Yukishiro1 posted:
Tych2 posted:
That plus also probably people faking injuries. Bad backs etc.
What's the incentive? The person doesn't get any money from that from medicare.
That sounds like disability fraud, not medicare fraud.
Or you mean they're faking for some other reason - probably disability - and medicare ends up paying for treatment for a fake injury? But how many people who get medicare are still working and have an incentive to try to pretend to be disabled?
I think the fraud is from medical institutions (Nursing Homes etc...) come to mind that bill Medicare for services for people that are dead or didn't get the treatment...
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