Medicare can be frustrating. The constantly changing rules, regulations, audit requirements, fee schedules – all of it. To receive pennies on the dollar from a system that has turned into a large distraction and huge disincentive to providers gets old for many, but it’s what we have to deal with to provide care through the failing system.
What’s even more frustrating is to hear in the Miami Herald about a South Floridian with a drug-trafficking conviction who successfully ran eight (count ’em) medical equipment companies using fake names, submitting over $48 million in false Medicare claims during his reign of fraud. While many of us were working hard to keep our expenses to the system low as we provided care to our Medicare population during 2005-06, this same criminal profited to the tune of $8 million, landing a quarter of that money in his own pocket.
And if he were the only one. In South Florida alone, medical equipment and HIV-infusion fraud amounts to a loss of $7 million per day by the Medicare system, or $2.5 billion per year. And how’s this for a statistic – investigators reported to congress that between the years 2000 and 2007, the identification numbers of 18,240 deceased physicians were used to rack up $92 million to fraudulent medical equipment providers.
Not that eliminating fraud would by itself save the Medicare system, but a $7 million-per-day hole in the taxpayers’ bucket from only one region of the U.S. is certainly evidence that there is a long way to go to get the system on the right track.
Read the full story from the Miami Herald here.
The Centers for Medicare and Medicaid Services, which manages the 43-year-old federal insurance program for the elderly and disabled, doesn’t have a specific amount for the cost of corruption nationwide. Internal audits mainly focus on billing mistakes, excessive payments and other waste with only a fractional measure of fraud. Therefore, the agency estimates its combined loss is $11 billion annually.
Private healthcare companies, credit card companies and other industries have implemented new technology to fight fraud aggressively, but Medicare has failed to adopt even the most basic changes that the U.S. Department of Health and Human Services’ inspector general has warned are sorely needed to combat the crisis.
Medicare, one of the government’s largest agencies, seems more intent on paying claims quickly than verifying them first, according to many critics and law enforcement officials.