March 22, 2010--Medicare Fraud 101
As we move closer to real health care reform, historic legislation, it may be time to begin to think about what is involved in implementing a comprehensive approach to expanding coverage while reducing costs.
For years we have been hearing that a large portion of the nation's annual cost for Medicare is a consequence of fraud and abuse. Doctors and hospitals charging for services not provided, ordering unnecessary tests, and insurance and pharmaceutical companies stifling competition.
By one conservative estimate this amounted to up to $100 billion, with a B, in 2009. Obviously, just cutting this in half would be of significant help in reducing the ballooning cost of health care, save taxpayers money, and would help pay for the costs associated with expanding coverage to the uninsured.
All good things, and up to this point all empty political promises trotted out when our leaders want to show us that they are being tough about spending our money.
In all of the debate that has raged for 15 months about Obamacare and the health care bill working its way through Congress, Republicans and Democrats alike have spoken many words about reducing fraud and abuse. But I have not heard hardly anything about how this might be accomplished.
Specifically, how do Obama and Congress plan to get after this massive waste?
Thanks to a Website, Medicare Fraud 101 (link attached below) I now know.
The Obama plan has been proven to work in a number of trial runs and, best of all, it will cost us, taxpayers, very little to implement. Here's how it would work:
His anti-fraud approach includes hiring private auditing firms, called Recovery Audit Contractors (RACs) to comb health care businesses—including doctors’ billing records—for health care fraud and abuse. The auditors, like whistle blowers, would keep part of what they help to recover.
According to the Associated Press, Medicare pilot programs, using such auditors, recouped $900 million for taxpayers between 2005-08. Not yet the billions in savings promised, but these were small scale, pilot approaches and occurred during Bush administration years when any sort of auditing of corporations or businesses was not a priority.
It is thought that the RACs will provide a huge savings to taxpayers, at minimum cost, just because of the deterrent effect alone. Think about how fear of an IRS audit keeps most of us from not cheating (too much) on our taxes!
For years we have been hearing that a large portion of the nation's annual cost for Medicare is a consequence of fraud and abuse. Doctors and hospitals charging for services not provided, ordering unnecessary tests, and insurance and pharmaceutical companies stifling competition.
By one conservative estimate this amounted to up to $100 billion, with a B, in 2009. Obviously, just cutting this in half would be of significant help in reducing the ballooning cost of health care, save taxpayers money, and would help pay for the costs associated with expanding coverage to the uninsured.
All good things, and up to this point all empty political promises trotted out when our leaders want to show us that they are being tough about spending our money.
In all of the debate that has raged for 15 months about Obamacare and the health care bill working its way through Congress, Republicans and Democrats alike have spoken many words about reducing fraud and abuse. But I have not heard hardly anything about how this might be accomplished.
Specifically, how do Obama and Congress plan to get after this massive waste?
Thanks to a Website, Medicare Fraud 101 (link attached below) I now know.
The Obama plan has been proven to work in a number of trial runs and, best of all, it will cost us, taxpayers, very little to implement. Here's how it would work:
His anti-fraud approach includes hiring private auditing firms, called Recovery Audit Contractors (RACs) to comb health care businesses—including doctors’ billing records—for health care fraud and abuse. The auditors, like whistle blowers, would keep part of what they help to recover.
According to the Associated Press, Medicare pilot programs, using such auditors, recouped $900 million for taxpayers between 2005-08. Not yet the billions in savings promised, but these were small scale, pilot approaches and occurred during Bush administration years when any sort of auditing of corporations or businesses was not a priority.
It is thought that the RACs will provide a huge savings to taxpayers, at minimum cost, just because of the deterrent effect alone. Think about how fear of an IRS audit keeps most of us from not cheating (too much) on our taxes!
posted by Steven Zwerling at
5:42 AM
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