As the Senate debates healthcare reform and how the additional coverages would be provided, why aren't they talking about the $90 billion that has been given away for free through Medicare fraud?
A private company would close their doors if all of their earnings were being stolen by clients. Why does the government create programs which make it possible for fraud to easily take place?
Those of us in the healthcare industry are aware of the stories which circulate about medical equipment companies who are billing improperly to Medicare (even the Scooter Store, which advertises heavily on television with infomercials, settled a lawsuit with the federal government after an employee blew the whistle on improper claims). Part of the problem stems from government programs which make some reimbursements a bit too large, as compared to the profitability a company would earn in the private sector - but shouldn't government pay the same as the private sector pays for products (or less, if they are guaranteeing bulk orders)?
From the government's news release on the Scooter Store fraud:
"By representing to physicians that their patients wanted and needed power wheelchairs, The SCOOTER Store obtained thousands of “Certificates of Medical Necessity” from physicians who did not know about the company’s fraudulent practices. The SCOOTER Store then billed government and private health care insurers for power wheelchairs, which were far more costly than power scooters, and collected millions of Medicare and Medicaid dollars.
The SCOOTER Store received $5,000 to $7,000 in reimbursement for each power wheelchair it sold, more than twice the amount for a scooter, which sold for around $1,500 to $2,000. Many beneficiaries had no idea what kind of equipment they were getting, until it was delivered by The SCOOTER Store.
The government’s lawsuit also alleged that The SCOOTER Store knowingly sold used power mobility equipment to beneficiaries and billed Medicare as if the equipment were new, in violation of Medicare regulations. In addition, the U.S. alleged that The SCOOTER Store charged Medicare millions for unnecessary power mobility accessories."
If seems if the government could just cut out the programs that have a bit too much frosting and whipped cream on top for certain industries, and created efficient systems for reimbursement, the billions in fraud that are saved would more than pay for additional healthcare benefits.
Check out this 60 Minutes story which aired on October 25, 2009, and profiles the billions being stolen from Medicare via fraudulent claims. It seems it would not be that difficult to set up a better system for checking out claims to avoid this fraud, especially when people aren't just stealing a million or two million, but million after million after million without being caught.
Medicare does not pay for long-term care and because of this, many seniors must hire their own senior caregiver and the additional cost of providing health insurance for senior caregivers is not always covered by small businesses or when a caregiver is hired directly (or when a family member must quit their job to provide for the care).
Meanwhile, studies show the most important factor in senior care is one-on-one care services by a caregiver. Even Medicaid-funded nursing homes often do not staff more than 1 Certified Nursing Aide for each 12 residents, which often means this nursing aide cannot adequately provide care to each senior.
It seems eliminating the extremely high Medicare reimbursements for some medical equipment would be the first easy fix to help pay for more health insurace benefits for Americans, including benefits for senior caregivers.
, Medicarefraud senior