patrick.net

Medicare pays companies to tell it what to pay to providers. These companies tell Medicare it's okay to pay a bill that's fradulent - and it's 100% Medicare's fault? I think not.

ZippyDDoodah says

Single payer does not = single provider. The fraud has occurred in paying out to health care providers

If all of the medical care payments ran under the same rules, we wouldn't have asinine rules & denials. If healthcare weren't a massive for-profit system and was patient-based, rather than profit-based, we would have better care for all.

Right now, with all the cutbacks at the state level, providers aren't being monitored. Payments are processed and no one's watching. Private companies are the ones that are perpetrating fraud, private companies are the ones that are authorizing payment, but it's the govt's fault?

I'm gonna agree to disagree with your sadly misinformed posts.

"Often they’ll do this, knowing that the employer will have no alternative but to leave. And that happens all the time,” he explained.

I'm sure it's happened. In some cases such raising of rates may be justified, in other case not. I'd be interested to see statistics which quantify the "all the time" claim. Without facts, it sound like too much like unsubstantiated emotional blustering

If all of the medical care payments ran under the same rules, we wouldn’t have asinine rules & denials.

Yet Medicare payments are all made out under the "same rules" and we have have $60 billion in fraud every year as a result. Please explain how a single payer system would be any different

elliemae says

I’m gonna agree to disagree with your sadly misinformed posts.

You're late to the party. I will say that private companies, when spending their own money, are tight as hell and don't care whose life they destroy as long as the profits continue to roll in. When dealing with the government's money, they approve everything possible because that's how they make their money. If they were required to pay half of the fraudulent claims back, they'd certainly change their tunes.

Btw, it's an "estimated" 60 billion in fraud - because if they actually knew it was fraud it wouldn't happen now, would it?

Btw, it’s an “estimated” 60 billion in fraud - because if they actually knew it was fraud it wouldn’t happen now, would it?

Did it ever occur to you that fraud is discovered AFTER payments are made? http://ur.lc/iya What a surprise!

I will say that private companies, when spending their own money, are tight as hell and don’t care whose life they destroy as long as the profits continue to roll in. When dealing with the government’s money, they approve everything possible because that’s how they make their money. If they were required to pay half of the fraudulent claims back, they’d certainly change their tunes.

But the administrators paying out Medicare money are simply following Medicare's rules, no? They pay the bills within the rules of the Medicare payment system.. Unless you have evidence otherwise. The vast majority of Medicare fraud, to my knowledge, is coming from fraudulent payment claims from providers. Medicare has no incentive to stop the massive fraud because they just take more $$$ from taxpayers. Private health insurance companies with their survival at stake could never survive with a tiny fraction of the fraud that Medicare lets slide every year

ZippyDDoodah says

Did it ever occur to you that fraud is discovered AFTER payments are made?

Sure. But there's plenty of ways to find it beforehand, if anyone's looking. A few examples:

-companies that solicit customers for jazzy chairs and scooters, insisting that patients won't have to pay out of pocket. I've seen a lot of unnecessary ones handed out. And there's no payment for used models - if a lesser amount would be paid for a used model we'd save a substantial amount. These chairs cost $6,000 or more new, while a used one goes for $500 +/-.

-hospices that sign anyone on, and if the patient improves they keep the patient on service for 3 months before discharging. It costs you and me $12,000 for this little scheme. And they'll keep patients on service forever.

-hospice in a nursing home paid at the same rate, when nursing homes are providing a much higher level of care than the patient would have at home. The hospice receives the same amount of money while the nursing home is penalized 5% of reimbursement rates under Medicaid.

-equipment sent to people in the mail because they answered the phone.

-companies that advertise they'll provide diabetic supplies for low or no cost to patients. They send the most expensive items and bill Medicare.

...and on, and on, and on...

A single payor system would take care of that. Less of a chance to game the system when it’s one agency paying the bills.

ellie, you made that claim and I asked you to back it up with any citations because it sounds ridiculous. As of now, I guess you simply made it up. I mean, paying to the same "system" is like Medicare's "same system" which allows for $60 billion in fraud each year. Too many liberals like you are wedded to a narrative instead of acknowledging the obvious massive shortcomings in the types of systems (Medicare being a prime example) that you are advocating.

I appreciate your concern with waste and fraud, although you seem to be oblivious to the fact that government has no incentive to control it. Unless a person perceives that his job or his bonus will be lost if he doesn't personally crack down on fraud, nothing will be done. In government, no such incentives to crackdown on fraud exist, because there is no profit/loss motive. Hence, massive fraud. It's inherent to the system.

ZippyDDoodah says

Too many liberals like you are wedded

No, I'm divorced but I am in a relationship. Thanks for your interest in my personal life.

Zippy, you know not whereof you speak. I owe you no citations, you're late to the party and you're ill informed if you think that all "liberals" think the same.
On the other hand, it seems to be easier for you anti-dentites to label people according to your narrow views than to admit that individual people are able to think for themselves. I happen to have my own opinions - they're real and they're fantastic!

-Mulva

Zippy, the reimbursement rate for Medicare is about 1/2-3/4 of private insurance. So what's the savings rate for Medicare pt's/government when compared to private insurance reimbursement?

Ever wonder why doctors limit the number of Medicare patients they see?

ZippyDDoodah says

Zippy, you say that Medicare fraud is a government issue - but it’s perpetrated by private companies, and private contractors to Medicare are the ones authorizing the payments. So it’s a private thing too
By your own admission in other threads, Medicare’s “system” gives no incentive not to pay, so it’s not “equally” the fault of private industry as you suggest. Medicare is responsible is for the fraud in their own program, period. In fact, private medical insurers would go bankrupt if they permitted only tiny fraction of the fraud which takes place under Medicare every year. Quit making excuses for the massive fraud

Let me see if I understand this. Committing fraud is not the fault of private industry who plan and perpetrate it because Medicare doesn't always catch it. That's simply the most amazing use of logic I have ever seen. I always thought that the cornerstone of conservative thought was taking responsibility for your own actions. I didn't realize there was an "except when participating in criminal activity against the government" clause.

bob2356 says

Committing fraud is not the fault of private industry who plan and perpetrate it because Medicare doesn’t always catch it.

Don't forget that CMS pays bills that private contractors have determined should be paid out of medicare dollars. But it's Medicare's fault. Wait, I need another hit... Okay, it makes sense now.

Let me see if I understand this. Committing fraud is not the fault of private industry who plan and perpetrate it because Medicare doesn’t always catch it.

Many of the private industry Medicare providers are most definitely guilty and should be punished with heavy fines and jailtime. But because they're dealing with Medicare, they know that they're dealing with a bureacracy which finds it "easier to pay" the fraudsters rather than crackdown as would a company in private industry. As a result, we have $60 billion in Medicare fraud every year (and growing?). Medicare is responsible for this fraud. Incredible to see so many leftists on this thread defend it because the massive scale of Medicare fraud makes clear that large scale govt. "solutions" to healthcare can never be anything but wasteful and fraud-ridden

Those who are administering the payments, the 'accounts payable' group of subcontractors to Medicare like insurance companies are simply following Medicare's rules, doing what Medicare tells them to do.

So if you rob a bank, it's the bank's fault because the teller gave you the money? We get it - you hate libs, believe that the ills of the world are all our fault and we suck. Can we move on now?

So if you rob a bank, it’s the bank’s fault because the teller gave you the money?

That's an incredibly dishonest characterization of what I wrote ellie. It's the only way you can make your "points". In your little example, the teller, like Medicare administrators, are simply doing their job.

A more honest analogy would have been the "Medicare bank" not hiring security, not using security cameras, and refusing to investigate theft because it's easier to just let the theft slide.. because they know they can always go back to taxpayers to refund the bank's losses

In my "littel" example? Medicare hires the companies to tell them what to pay. Doesn't the private company have a responsibility to not authorize the payments - or to report suspected fraud so that it will stop happening?

42 C.F.R. § 405.371(b) (1992) says:

However, where fraud or misrepresentation is suspected, notice may be provided concurrently with the suspension. Amounts suspended are segregated. Once imposed, a suspension remains in effect until either the overpayment is returned, a liquidation agreement is reached with the supplier, or the agency determines that no overpayment was made. 42 C.F.R. § 405.373 (1992).
http://www.justice.gov/usao/eousa/foia_reading_room/usam/title4/civ00085.htm

http://en.wikipedia.org/wiki/Charlene_Corley

This company, C&D Distributors, found that being a defense contractor worked well for them. It turns out that parts are paid out of one area, shipping for another. What started with an accidental billing (the invoice number was plugged into the area for shipping charges, and the invoice was paid an additional $5,000 for an $11 part) became a huge 25 million dollar fraud. The case that broke the proverbial camel's back was when the pentagon was billed $0.38 for two washers and $998,798 for shipping. According to a teevee show about it (American Greed), they double-billed for the washers and the invoices were kicked to an actual human for review. The perpetrators of the fraud were fined $15.5 million in restitution, jail time... and one of the owners of the company killed herself.

Should they end all defense spending because of some rather asinine accounting practices? According to what I've read, the billing problems occurred as a result of the DOD's desire to get stuff sent to the troops as soon as possible.

My point, Zippy, is that you don't end a program because there's fraud. You do your best to fix the system so that you have less (or no) fraud. Medicare does work for millions of Americans - it provides healthcare coverage to a population that otherwise wouldn't be able to afford huge premiums and who paid into the system for decades in order to reap the benefits of healthcare in their older years.

Is it perfect? No. But neither is private insurance. So we fix the areas that need it. Assigning blame to liberals (or conservatives, or white supremicists, or any other group) is short-sighted and socially irresponsible.

My point, Zippy, is that you don’t end a program because there’s fraud

Yes you do, if there's a viable alternative such as private health insurance which has a far superior track record in minimizing fraud and waste.

In the case of national defense, like with local police forces, I see no reasonable private alternative that would not threaten our safety and survival. So in those cases of national defense and local police, we are forced to tolerate inherently wasteful government programs. That doesn't mean that government has the right to control other industries such as healthcare where it has a well demonstrated track record of fraud and waste.

ZippyDDoodah says

Yes you do, if there’s a viable alternative such as private health insurance which has a far superior track record in minimizing fraud and waste.

...by denying healthcare proceedures, retroactively denying coverage and bankrupting people through denials and escalating premiums. As long as you're healthy, there's coverage. And, once again, these private companies of which you are so fond participated in fraud by not investigating and reporting. You know not whereof you speak.

I do hope that you never suffer the consequences of being unable to access healthcare - but until you do, or witness it firsthand, you simply don't understand.

I do hope that you never suffer the consequences of being unable to access healthcare

You mean like those who suffer and die waiting for medical treatment in Canada? You posture as if you're so compassionate. You're just a phony

ZippyDDoodah says

I do hope that you never suffer the consequences of being unable to access healthcare

You mean like those who suffer and die waiting for medical treatment in Canada? You posture as if you’re so compassionate. You’re just a phony

And you, sir, are an ill-informed anti-dentite. Wait lists happen here, too. What does that have to do with the fact that private companies are at least in part responsible for Medicare fraud?

I know, libs bad, conservos good.

Yawn.

ZippyDDoodah says

I do hope that you never suffer the consequences of being unable to access healthcare

You mean like those who suffer and die waiting for medical treatment in Canada? You posture as if you’re so compassionate. You’re just a phony

So no one has died in America after being denied care or waiting for an insurance company to reply? Amazing, I didn't know that. You know nothing about how the Canadian system works by the way.

You know nothing about how the Canadian system works by the way.

And you base this conclusion on what bob? Remember what happened the last time you challenged me on the facts? At least back then when you had egg on your face, at least you had the moral integrity then to do a mea culpa which is more than 95% of what your leftist fellow travelers on this site are willing to do whenever they are proven dead wrong. You have a admirable amount of honesty, but if you were brighter, you would learn from past errors. You relish in your ignorance instead of learning from the humiliation that it brings you.

You seem to suggest that Canadian healthcare wait lists are not much of a problem in their health care system. Please do elaborate on that position so that we can better understand your base of "knowledge" on this subject

ZippyDDoodah says

which is more than 95% of what your leftist fellow travelers on this site are willing to do whenever they are proven dead wrong.

Please quote your source.

ZippyDDoodah says

At least back then when you had egg on your face

Please show evidence that Bob-o had eggs on his face. Acceptable forms of proof would be a photograph, or lab report displaying the ratio of egg to other foods he might have on his face. Please note that left-over lunch in his mustache doesn't count unless it contains eggs.

ZippyDDoodah says

but if you were brighter

The joke shall be on you if the eggs of which you speak were sunny-side up...

ZippyDDoodah says

You relish in your ignorance instead of learning from the humiliation that it brings you.

Relish? He's in a real pickle now.

ZippyDDoodah says

Remember what happened the last time you challenged me on the facts? Please do elaborate on that position so that we can better understand your base of “knowledge on this subject

Do you want him to elaborate on his position, or describe wherefrom he got his knowledge? Actually, it appears that you simply want to make statements that allow you to feel superior.

ZippyDDoodah says

they are proven dead wrong

The only thing that you've proven is that you like to attack people who disagree with you. We get that.

ZippyDDoodah says

You know nothing about how the Canadian system works by the way.

And you base this conclusion on what bob? Remember what happened the last time you challenged me on the facts? At least back then when you had egg on your face, at least you had the moral integrity then to do a mea culpa which is more than 95% of what your leftist fellow travelers on this site are willing to do whenever they are proven dead wrong. You have a admirable amount of honesty, but if you were brighter, you would learn from past errors. You relish in your ignorance instead of learning from the humiliation that it brings you.
You seem to suggest that Canadian healthcare wait lists are not much of a problem in their health care system. Please do elaborate on that position so that we can better understand your base of “knowledge” on this subject

I'm still waiting for your research to back up your original assertion that people with higher deductions will result in lower systemic health care costs. The only thing I have egg on my face is the fact that I was in error on was the level of deductions which is totally irrelevant to your assertions.

You made the claim Canadian doctors are all second rate losers, you back it up.

I've lived and worked in Europe, Canada, Central America, and the South Pacific without ever having any problems with the health care system. You managed to visit 2 countries and find 2 incompetent doctors. Pretty amazingl

You made the claim Canadian doctors are all second rate losers, you back it up.

I never said "all" in the literal sense, but in general, the better Canadian doctors have moved or are moving to the US for the obvious reason that there are better opportunities for them beyond what the socialized healthcare system of Canada offers them http://ur.lc/j27 . Canadian vs US salaries of doctors here: http://ur.lc/j28 . Common sense dictates that many of the better doctors would be drawn to where the opportunities for them and their families is best. It's not like this is rocket science to figure out

I've never seen as incompetent doctors (2 out of 2 doctors in Montreal) as I experienced in Canada. Instead of running tests to determine the cause of an itching rash on my back, the 1st doctor told me to use some over the counter cream, and when it continued to worsen, I went to a 2nd doctor there who also did not run any tests, but pulled out a book (seriously) to try and figure out what it was. Two days later I flew into New York and a medical intern from one of the 24 hour doc-in-the-box facilities solved it immediately with an anti-inflammatory shot and a precautionary test just to make sure it was nothing more serious. This is admittedly anectdotal, but 2 for 2 cartoonishly incompetent doctors?

ellie wrote:

The only thing that you’ve proven is that you like to attack people who disagree with you. We get that.

You're repeated that worn out "We get that" enough times in many threads... likely because it's one of your safety blanket talking point retorts that you repeat over and over and over.

It's rich to hear ellie complain about "attacks" when I was responding to a direct insult, especially when on this very thread she 'attacks?' me as "sadly misinformed", "ill informed" and "short-sighted and socially irresponsible".

ZippyDDoodah says

I never said “all” in the literal sense, but in general, the better Canadian doctors have moved or are moving to the US for the obvious reason that there are better opportunities for them beyond what the socialized healthcare system of Canada offers them http://ur.lc/j27 . Canadian vs US salaries of doctors here: http://ur.lc/j28 . Common sense dictates that many of the better doctors would be drawn to where the opportunities for them and their families is best. It’s not like this is rocket science to figure out

Did you actually read the article the that blog was based on? Or just the headline?
http://mdsalaries.blogspot.com/2007/10/canadian-versus-american-physician.html
http://media.www.mcgilltribune.com/media/storage/paper234/news/2007/10/16/Features/Scalpels.And.Salaries.Where.Do.Doctors.Cash.In.The.Most-3033668.shtml
Go read the article and the comments. The blog takes much information out of context and draws very dubious conclusions. The salary article also takes some very serious liberties with their comparisons. What doctors make in Canada in the public system doesn't reflect what they earn in private practice. Canada, like most of the first world has a public/private system providing a basic level of care within the public sector then allowing people to purchase insurance (which is very inexpensive) if they want to see physicians in the private sector.

You also missed the point that in addition to money the primary reason doctors are coming to the US from Canada is the specialist positions in Canada are all filled. From the article.
"Although there's a shortage in general practitioners in Canada, the CMA reports that most jobs for sub-specialists in Canada are unavailable, which can lead to relocating to the US."
The US also has a shortage of GP's and a glut of specialists. Canada is wisely trying to allocate their resources better.

ZippyDDoodah says

It’s rich to hear ellie complain about “attacks” when I was responding to a direct insult, especially when on this very thread she ‘attacks?’ me as “sadly misinformed”, “ill informed” and “short-sighted and socially irresponsible”.

It's your posts that lead me to that conclusion. The more you post, the harder it is to take you seriously.

When a patient presents with contact dermatitis, the first line of treatment is to do nothing beyond suggesting over-the-counter remedies except in extremely severe cases. Most patients (including Zippy) find it upsetting that they are not automatically given a shot of something, but 99.99% of the time dermatitis simply resolves spontaneously after a couple of days once the allergen is removed.

Except that it was explained to the 1st doctor that the rash had already persisted for several days and was getting worse. It was also explained to him that during that time, over the counter hydrocortisone and anti-itch creams were already tried and not working. His response was to speculate that it was chicken pox, even though I told him I had a bad case of chicken pox at age 5. The second Quack doctor was visited two days later when the rash continued to get worse. He was literally bewildered, pulling out a book to try and figure it out. This is not how "99%" of US doctors would have treated this same situation Nomo.

Interesting that when I explained the same thing to the medical intern at the doc-in-the-box in New York, he gave me a shot and solved it immediately.. without even having to pull out a medical book! You can't blame the exodus of better Canadian doctors to the US before Obamacare.

ZippyDDoodah says

It’s rich to hear ellie complain about “attacks” when I was responding to a direct insult, especially when on this very thread she ‘attacks?’ me as “sadly misinformed”, “ill informed” and “short-sighted and socially irresponsible”.

Are you saying ellie "I never insult anyone" mae actually does hurl insults? The next thing you'll say is she's a hypocrite. Shocking!

RayAmerica says

Are you saying ellie “I never insult anyone” mae actually does hurl insults? The next thing you’ll say is she’s a hypocrite. Shocking!

Jeez, rayray. Do you hate everyone who disagrees with you, or am I number one? Because you have to feel passionately about someone to focus on them so much, the way that you vie for my affection (or lack thereof). This schoolboy crush is kind of cute.