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Medicare rant - its getting bad

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Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,874
4,203
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Here is the break down of the fraud and the return in revenue.

It's 97 pages so you better loadup the printer before hitting "print" ;)

http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2011.pdf
I read rather quickly :p

This isn't a comprehensive list, but highlights which are naturally going to point to favorable cases.

I'm not saying that there isn't true fraud because that would be a lie, and it needs to be punished. I will call your attention to titbit.

In April 2011, Dartmouth Hitchcock Clinic, Mary Hitchcock Memorial Hospital, and related entities (collectively Dartmouth), agreed to pay $2.2 million to resolve its liability under the FCA for allegedly submitting improper claims to Medicare, Medicaid, TRICARE, and the Veteran’s Administration.

Between February 1, 2001 and September
30, 2007, Dartmouth’s Anesthesiology Department (AD) allegedly submitted improper claims for services not supervised by attending physicians in the AD’s Pain Clinic,28 submitted improper claims for services not supervised by attending physicians related to bedside procedures, and submitted improper claims for time based billings in the AD’s Critical Care Unit.

According to federal regulations and related guidelines, physicians are allowed to bill for certain services provided by residents, but only if those services are performed while a physician is present and the medical record documents physician presence.
Note that there is no medical impropriety here. No question of the qualification of those involved. The government created this regulation based on something other than medical necessity and unfortunately many institutions learned of this requirement hidden among the regs after an audit. Properly trained people were giving the needed treatment correctly and got snagged because of a nonsense regulation. Why? Because then can be. Reasonableness is not a requirement of regulation.
 

fskimospy

Elite Member
Mar 10, 2006
70,097
18,864
136
Wait, the government does a shakedown and the solution is to hand the whole thing over to a more powerful authority even further distanced from the people?

The worst of the local cases

Note that there was no mention of a single prescription filled with the intention of not providing the correct medication to the correct patient. There is also no explicit rule which deals with delivery documentation. It was an interpretation of a rule which did not mention deliveries at all, but the auditor said it should. The other issue of MD identifiers is that there are several IDs in use and they aren't always updated by the software vendor. The correct doc was on the label however rather than rejecting the claim Medicaid if there was incorrect information it allowed it to go through and after the fact the "analysis" gave ammunition to attack the owner. Nothing was billed for which wasn't provided.

In the end the owner went out on a limb and at considerable expense fought this and won.

The "crime"? Failing to follow rules which aren't there and having an incorrect number is a computer system that the powers that be could have stopped like any other insurance company but allowed to go through to profit by later.
No, it's an issue that needs to be addressed. The fact that single payer is massively superior to our current system is already pretty clear due to the overwhelming evidence from the entire rest of the developed world. It's clearly the solution.
 

JohnnyGage

Senior member
Feb 18, 2008
703
0
71
Massively superior? AHAHAHAHAHAHAHAHAHAHAHHA

That's hilarious. We've had this discussion, so go ahead and continue your beliefs. Although be careful what you wish for....
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,874
4,203
126
No, it's an issue that needs to be addressed. The fact that single payer is massively superior to our current system is already pretty clear due to the overwhelming evidence from the entire rest of the developed world. It's clearly the solution.
You have yet to put forward that OUR governments which have created these problems will do a better job with OUR UHC than it has with these issues. It won't be the Swedes or French or Germans who take charge it will be the Republicans and Democrats fighting for political positioning like every other major bill out there. Now if you can convince them to by each other a Coke and shower the world with love then go for it. I remain skeptical.
 

Ausm

Lifer
Oct 9, 1999
25,215
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Massively superior? AHAHAHAHAHAHAHAHAHAHAHHA

That's hilarious. We've had this discussion, so go ahead and continue your beliefs. Although be careful what you wish for....
I don't see any Seniors telling to shove their Mediscare up the Governments ass.
 

shadow9d9

Diamond Member
Jul 6, 2004
8,133
1
0
Massively superior? AHAHAHAHAHAHAHAHAHAHAHHA

That's hilarious. We've had this discussion, so go ahead and continue your beliefs. Although be careful what you wish for....
Pay less than half we do, covers everyone.. yes it has. This is why every other first world country chooses to us it. They don't let people die for profit's sake. They don't allow companies to reap profits from the healthy and young and then ask taxpayers to pay for the most expensive of the population(elderly).
 

rudder

Lifer
Nov 9, 2000
19,431
82
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I don't see any Seniors telling to shove their Mediscare up the Governments ass.
That is because the seniors get their care along with their electric scooter. Doctors on the other hand are the ones going bankrupt treating medicare patients.
 

Ausm

Lifer
Oct 9, 1999
25,215
13
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That is because the seniors get their care along with their electric scooter. Doctors on the other hand are the ones going bankrupt treating medicare patients.
Hmm my Doctor seems to be doing great but he works in a healthcare system that cover the whole Midwest.
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,874
4,203
126
I don't see any Seniors telling to shove their Mediscare up the Governments ass.
Tell you what. Give them what they paid into it over their lifetimes plus accumulated interest and let them buy their own healthcare.
 

Ausm

Lifer
Oct 9, 1999
25,215
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Tell you what. Give them what they paid into it over their lifetimes plus accumulated interest and let them buy their own healthcare.
The average Senior couldn't afford Private coverage and if the GOP repeals the affordable Healthcare Act, A majority of Seniors would be denied due to pre-existing conditions.
 

JohnnyGage

Senior member
Feb 18, 2008
703
0
71
Pay less than half we do, covers everyone.. yes it has. This is why every other first world country chooses to us it. They don't let people die for profit's sake. They don't allow companies to reap profits from the healthy and young and then ask taxpayers to pay for the most expensive of the population(elderly).
Trust me, no one dies for profit here, its the other way around. I could give examples but I can't violate Hippa laws.
 
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JohnnyGage

Senior member
Feb 18, 2008
703
0
71
The average Senior couldn't afford Private coverage and if the GOP repeals the affordable Healthcare Act, A majority of Seniors would be denied due to pre-existing conditions.
Umm yeah that happens rarely as well. My parents have good supplemental and have an unbelievable amount of pre-existing conditions and lots of visits to the pharmacy. They are in their 70's.

Keep rollin' with your fantasy though....

Edit: Being in the healthcare industry, rarely does someone get denied for something they actually need.
 
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soundforbjt

Lifer
Feb 15, 2002
15,872
3,449
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Umm yeah that happens rarely as well. My parents have good supplemental and have an unbelievable amount of pre-existing conditions and lots of visits to the pharmacy. They are in their 70's.

Keep rollin' with your fantasy though....

Edit: Being in the healthcare industry, rarely does someone get denied for something they actually need.
So your parents are the norm for all seniors? Talk about fantasy.
 

Hayabusa Rider

Admin Emeritus & Elite Member
Jan 26, 2000
50,874
4,203
126
The average Senior couldn't afford Private coverage and if the GOP repeals the affordable Healthcare Act, A majority of Seniors would be denied due to pre-existing conditions.
Yes they would. Perhaps a more targeted and thought out process would offer the solution. I do think you underestimate the lifetime contribution of people after compound interest is taken into account though.

Here's a thought on the general subject. Instead of punishing people by forcing them to by something they may or may not be able to afford perhaps we ought to include health care premiums as part of medical deductions. The catch is that if you don't buy the plan you don't get the break no more than you would a deduction for owning a home if you don't have one. Remarkably absent in this discussion is that there are already mechanisms in place for tax breaks for energy savings and other beneficial things. We don't tax people for not having better insulation or solar, we reward them. We could do much the same.
 

Ausm

Lifer
Oct 9, 1999
25,215
13
81
Umm yeah that happens rarely as well. My parents have good supplemental and have an unbelievable amount of pre-existing conditions and lots of visits to the pharmacy. They are in their 70's.

Keep rollin' with your fantasy though....

Edit: Being in the healthcare industry, rarely does someone get denied for something they actually need.
Crack kills...enjoy your fantasy. He's talking about ending Mediscare and seniors relying on private insurance only not a fucking supplement....
 

JohnnyGage

Senior member
Feb 18, 2008
703
0
71
Crack kills...enjoy your fantasy. He's talking about ending Mediscare and seniors relying on private insurance only not a fucking supplement....
Fine, and with that, seniors have been paying into medicare all their lives and most seniors are on it with a supplement. They don't even use private insurance because they don't work. It's rare to see a senior on 100% private insurance, though it happens.
 
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soundforbjt

Lifer
Feb 15, 2002
15,872
3,449
136
Fine, and with that, seniors have been paying into medicare all their lives and most seniors are on it with a supplement. They don't even use private insurance because they don't work. It's rare to see a senior on 100% private insurance, though it happens rarely.
They're called the 1%. :)
 

piasabird

Lifer
Feb 6, 2002
17,183
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So how do you decide if a given knee or hip replacement is necessary? It is quite possible if you are a specialist and surgery is paying the bills, that you might push that option because you want the government money. Without knowing each and every case it is hard to say. A lot depends on the level of pain and the quality of life. However, if people are living longer and longer they will wear out these kind of joints. I saw people in the military with lots of bad knees.

One big problem is that in the USA a lot of people have problems with brittle bones because they are told not to drink milk or eat cheese to lose weight. So more people have brittle bones. However, if you take a Vitamin D3 supplement, that can really help a lot to keep your bones healthier.
 

Ausm

Lifer
Oct 9, 1999
25,215
13
81
Fine, and with that, seniors have been paying into medicare all their lives and most seniors are on it with a supplement. They don't even use private insurance because they don't work. It's rare to see a senior on 100% private insurance, though it happens.
I think we are on the same page.
 

rudder

Lifer
Nov 9, 2000
19,431
82
91
Hmm my Doctor seems to be doing great but he works in a healthcare system that cover the whole Midwest.

This can only be one of two things:

a) Your doctor only a very small percentage of medicare patients he sees and limits the number of new medicare patients
b) or you just like making bullshit statements for the sake of making them.
 

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