Medicare Fraud: Problems Persist With Contractors Paid Millions To Ferret Out Bogus Bills

[udbcrzy2]

Source: Huffington Post

MIAMI — Contractors paid tens of millions of taxpayer dollars to detect fraudulent Medicare claims are using inaccurate and inconsistent data that makes it extremely difficult to catch bogus bills submitted by crooks, according to an inspector general's report released Monday.

Medicare's contractor system has morphed into a complicated labyrinth, with one set of contractors paying claims and another combing through those claims in an effort to stop an estimated $60 billion a year in fraud. The U.S. Department of Health and Human Services inspector general's report – obtained by The Associated Press before its official release – found repeated problems among the fraud contractors over a decade and systemic failures by federal health officials to adequately supervise them.

Investigators found that health officials did not consistently evaluate key measures such as how many investigations were initiated by contractors. Investigators examined two contractors in charge of fraud hot spots in Florida and Texas during a nine-month period.

Contractors also used different types of data, some of which was inaccurate. That makes it impossible to determine if the contractors are effective, leading critics to question how it's possible to adequately monitor them.

Read more: http://www.huffingtonpost.com/2011/11/14/medicare-fraud-contractors-report_n_1091843.html

[hedgehog]

1. My MIL is dying; her body is no longer making platelets. There is

a slight chance chemo therapy will help her, but it will also cause many side effects. Since she was admitted to the hospital, she's had a pace maker installed and a colonoscopy. There were reasons for both of these procedures, but my gut feeling tells me that they haven't improved her comfort level (ever gone through the prep for a colonoscopy?) and haven't improved her health or possible outcome.

At one point, the Health Care Reform Act included data gathering to determine the benefits of various procedures. I don't know if this data collection made it into the final bill. Mind you, I don't really give a damn about the costs if there is a real benefit. But Medicaid was designed to ensure our elders got good medical care, not to provide a generaous income for specialists!

[DURHAM D]

2. Medicaid or Medicare?

last paragraph

[hedgehog]

3. Sorry, Medicare.

[zalinda]

4. The bigger question is, why is the government

hiring expensive contractors to do what it did better and at a cheaper cost? All this 'shrinking' of government has really cost the government a lot more money than if they hired the people themselves, and it did a better job. We end up paying CEO's a shit load of money for just being a figurehead, so to speak. The real work is done by the grunts, and since they have no real leader the job ends up being shoddy.

zalinda

[valerief]

6. All you have to do is buy Congress for that to happen. nt

[noiretextatique]

8. yet another example of the pitfalls of privitization

i wonder how many of our legislators have ties to these contractors?

[Philosopher King]

5. Anytime one party provides a service to another, and a third party picks up the tab,

fraudulent conduct should be expected.

Taking this into account, I am surprised by a couple of things: First, I would have estimated the cost of the fraud to be greater than $60 billion; and secondly, I am dumbfounded by the fact that many people insist that this is a very efficient program.

[jwirr]

7. To paraphrase raygun: Contractors are not the answer they are the

problem. Government is non-profit they are not. Well not all of them are. The adult center for my daughter is non-profit.