Economy $50 Billion in Medicare money are wasted each year to "improper payments".

[Anung Un Rama]

I bet Aetna, does 200 billion in fraud a year.

Its more difficult to fraud private insurance due to pre-authorizations, but its not impossible.

 

[ocean size]

medicare/medical same people pay into both, same cess pool

Is that an autocorrect for Medicaid?

 

[Amerikuracana]

So the answer to a government program that wastes “50 billion” due to mismanagement is to create and even bigger program run by the same people who made the original program?

Naw it's crooked doctors, often foreign, ripping off a system with not enough oversight and what seems to them like unlimited money.. Because they are doctors and that's a license to be rich; end of story for them.

For profit medicine has failed. Doctors are less ethical than lawyers right now. Heard fox news lying about how many more trillions universal would cost after their audience applauded the idea, but if we stopped doctors like the Dearborn doctors (just a couple) who ripped off the state gov for well over 100,000,000 over a few years, I think we know it wouldn't really cost more than it costs now; the insurance lobbies would just not like it, and in our current system in Washington, that's like everything.

 

[Beechwood]

There certainly is a great deal of fraud in our medical system. Saving billions in Medicare and Medcaid spending wouldn't be to difficult to bring about I imagine if the political will is there to stop the fraudulent spending.

It reminds me of that Sean Connery quote in the movie The Untouchable when the liquor raid is done on the Post Office - Everyone knows were the booze is, it's just a matter of who is willing to cross Capone.

 

[OverCoronavirus Pressure]

Here we go, the war on the homeless. Awesome, fuck the poor!

 

[cincymma79]

I’m not surprised at improper billing. I just did a project which involves charging for a bunch of hospitals in the vast majority them were charging incorrectly. To be fair, the charges are written so poorly that I can be very difficult to tell what to use for what. We’ve been having meetings for almost a year over just one department

 

[Renard]

So the answer to a government program that wastes “50 billion” due to mismanagement is to create and even bigger program run by the same people who made the original program?

Even with some amount of inefficiency, UHC is ridiculously more cost-effective because it's non-profit and there aren't mooches looking to extract the maximum amount of money from sick people at every step of the way like the US (insurance, hospitals, pharmaceutical companies)

TOTAL HEALTH EXPENDITURE PER CAPITA

https://www.oecd-ilibrary.org/socia...health-spending/indicator/english_8643de7e-en

There's also a shit ton of OECD reports analysing and comparing healthcare services in member countries.

 

[PEB]

The question you have to ask is does private insurance waste more?

If we went with Medicare for all we would replace private insurance and the amount that comes out of your paycheck to insurance would go to the government.

It's very possible that Medicare is more wasteful than private insurance but without seeing a comparison it's hard to say.

I do know that the government audits hospitals and healthcare providers for Medicare services. This itself could be a waste but I'd like to see a comparison

When CVS bought out a big healthcare insurer they gave the CEO a 500 million dollar pay package you suppose someone has to pick that up. Billions are flying all over the place an none of its going towards making healthcare more affordable.

 

[Beechwood]

One way to lower drug prices is to once again make it difficult for pharmaceutical firms to advertise on TV. It used to be that in order for a drug to be advertised all the side effects had to be listed. Having to list all side effects made it impossible to advertise.

Then a number of years ago that requirement changed to that only the top couple of side effects had to be listed. Now we see drug advertisements on TV constantly. Only two nations in the world allow this, the US and New Zealand.

We pay for the drug adds with higher drug prices. We don't need the advertisements to educate us. Doctors who prescribe drugs are supposed to be the ones that educate patients on best drugs to take for conditions.

 

[Arkain2K]

Watchdog Finds Another $6.7 Billion in Questionable Medicare Payments to Insurers
By Bowen Xiao | December 12, 2019

A government watchdog has identified major concerns relating to health insurers exaggerating how sick their Medicare patients were, resulting in nearly $7 billion in improper payments, according to a report released on Dec. 12.

The study, released by the U.S. Health and Human Services (HHS) Office of Inspector General (OIG), stated that Medicare Advantage plans sold to seniors and disabled people by health insurers received an estimated $6.7 billion in payments during the year of 2017.

The payments were made after insurers added diagnoses to patients’ files that weren’t supported by their medical records.

Authors of the report said they initiated the study due to concerns that Medicare Advantage organizations (MAOs) potentially used chart reviews in order to increase risk-adjusted payments “inappropriately.” Chart reviews evaluate the data history of patients’ health.

Inspectors found that Medicare Advantage insurers had added diagnoses for diabetes, heart disease, and other conditions in 99.3 percent of chart reviews of patient information, even though they didn’t appear in records from doctors, hospitals, or other medical providers. Insurers deleted incorrect diagnoses less than 1 percent of the time, they found.

The authors found that MAOs “almost always used chart reviews as a tool to add, rather than to delete, diagnoses—over 99 percent of chart reviews in our review added diagnoses,” according to a summary of the report.

“Although limited to a small number of beneficiaries, almost half of MAOs reviewed had payments from unlinked chart reviews where there was not a single record of a service being provided to the beneficiary in all of 2016,” the summary continued.

The additional diagnoses boosted government payments to insurers by an estimated $6.9 billion, while the deleted information trimmed payouts by nearly $200 million, producing a net benefit of $6.7 billion for the companies.

“We could not see any services with the diagnosis and that raised a number of concerns,” Linda Ragone, a regional inspector general in Philadelphia and co-author of the report, told Reuters. “There is a vulnerability here that needs to be addressed.”

The report highlighted a group of 4,616 Medicare Advantage enrollees for whom insurers added a diagnosis that resulted in a higher payment, even though there was no record of the person receiving any medical services during the year under review. The report didn’t identify any specific insurers by name.

The OIG also listed recommendations in their report including providing “oversight of MAOs that had payments resulting from unlinked chart reviews for beneficiaries who had no service records.” It also suggested conducting reviews that validated the diagnoses reported on chart reviews and to “reassess the risks and benefits of allowing unlinked chart reviews to be used as sources of diagnoses for risk adjustment.”

The U.S. Centers for Medicare and Medicaid Services (CMS) should be doing more to prevent insurers from exploiting this vulnerability, the OIG stated.

CMS didn’t immediately respond to a request for comment from The Epoch Times, but it told Reuters that it is “committed to ensuring that Medicare Advantage plans submit accurate information to CMS so that payments to plans are appropriate.”

In a Nov. 1 letter to the OIG cited in the report, CMS challenged the $6.7 billion estimate of payments linked to chart reviews as too high. The agency agreed with the report’s recommendations for increased oversight and audits.

Meanwhile, a report released on Nov. 25 by Sen. Rand Paul (R-Ky.) detailed wasteful spending by the federal government with a list of programs totaling $230,672,881 in wasted taxpayer money. Paul is the chairman of the Federal Spending Oversight and Emergency Management (FSO) Subcommittee for the Homeland Security and Governmental Affairs Committee (HSGAC).

The fall edition of “The Waste Report,” an annual series published by Paul, listed eight programs the federal government wastes taxpayer money on, including research on nicotine addiction using zebrafish, maintaining a failed self-cleaning toilet, and bringing Serbian cheese up to international standards.

The United States’ rising federal debt has reached more than 22 trillion dollars in total, with some economists describing it as an “insurmountable problem” inextricably tied with Washington’s longtime culture of spending and borrowing.

“It’s very unsustainable,” Dr. Chris Martenson, an economic researcher, and trend forecaster told The Epoch Times in a previous interview. “I consider the rising federal debt to be the equivalent of eating a really big meal at a nice restaurant and then leaving the bill for your kids.”

https://www.theepochtimes.com/watch...le-medicare-payments-to-insurers_3172546.html

 

[skysolo]

I hear what you are saying, TS. But here is the money to pay for medicare for all.

 

[D3thr0n3d K1ng]

And how much do the commercial insurance companies waste on marketing fees and over compensating their CEO?

 

[JSN]

Waste should be defined as payments delivered vs services provided.

I'm not really on the UHC side but I'd like to see those stats.

Which system gives the better return on investment? If it's private insurance with Medicare helping out the less fortunate let's keep going with that.

If UHC gives us the same or better coverage at a lesser cost let's go with that.

I really don't care about waste studies that have no comparison

please stop being rational ITT. You are clearly new to the War Room and unfamiliar with the rules of engagement.

 

[JSN]

I hear what you are saying, TS. But here is the money to pay for medicare for all.

Yeah but think of everything we got back.

 

[Happy Man]

50 billion annually here...

how many more billions in Social security fraud annually?

then add in the defense spending and waste and fraud there annually.

with all this wasted money, we could actually be fixing our infrastructure.

Pisses me off

 

[Arkain2K]

There are several things that Americans simply have to embrace as long as they keep voting for Democrats and Republicans, for it already became the status quo: Israel, Saudi Arabia, and Tax Waste.

No matter who's sitting in the White House, hundreds of billions of tax dollars went down the drain every single year with utter impunity, absolutely no one who are responsible ever get into trouble for it, and all you're going to see in the mainstream media are utterly pointless shit being rubbed into people's face day in and day out to distract them from the real issues that needs to be addressed.

I hear what you are saying, TS. But here is the money to pay for medicare for all.

May I ask who is this Third Party presidential candidate running on a platform of diverting defense spending over to medicare spending that you're voting for?

 

[skysolo]

May I ask who is this Third Party presidential candidate running on a platform of diverting defense spending over to medicare spending that you're voting for?

Is it really "defense" spending when it's a one-sided ass whopping and one side is taking the natural resource of the other?

 

[Deleted member 159002]

How about Sanderscare for all who want it and private insurance for those who don't? People with private insurance could have more options and shorter wait times, but pay more money for the convenience.