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OpEdNews Op Eds    H3'ed 3/25/10

CRIME DOES PAY When It Involves Medicare/Medicaid Fraud

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Yesterday, history was made when the United States Congress finally passed the Senate's version of health care reform that while not perfect, has the potential to radically change the quality of life for millions of Americans who desperately need health insurance but are unable to afford even basic coverage. This was not the bill that I wanted to see pass, but it's a start, and as bad as the Mainstream News Media and the GOP have distorted what this bill really encompasses, if our government uses some common sense, health care costs will be reduced for all, although that will happen only if the public presses the government to pass some important amendments that will drastically reduce the rampant fraud that is systemic throughout the Medicare/Medicaid programs. When you examine the numbers, reducing fraud alone in both of these programs would easily pay the costs to insure millions of Americans that currently have no health care at all and that would have happened years ago if the government would have exercised due diligence and aggressively acted to establish checks and balances that could help to eliminate rampant fraud that occurs in both programs.

The figures vary, and how much fraud that occur in the Medicare/Medicaid program(s) differs radically depending on whose figures you choose to quote. For all practical purposes, when it comes to defrauding the American taxpayer, Medicare/Medicaid fraud is by far the best game in the country to make billions of dollars with minimal punishment, and the amount of fraud is so great that if we could cut it by 75 to 80 percent I'm making an educated guess, based on the estimates for funding the program, that the new program(s) passed by Congress this weekend would require no additional taxpayer money to fund the programs and overall, health-care costs for the government and private health insurer's would both decrease dramatically.


Officials said Medicare pilferage is so widespread, with so much of it never detected, that no one can accurately say how much it costs American taxpayers. But a figure widely used by law enforcement officials suggests a staggering $60 billiona year is stolen from the national entitlement program, which funds medical treatment, equipment and prescriptions for 45 million seniors and the disabled.

"Every taxpayer funds the Medicare system," said Waterman. "We all pay taxes, we all pay for this. The people that are stealing from Medicare are stealing from us."

The amount of money stolen in any given scheme is on the rise, as criminals find new ways to tap into Medicare's automated computer system, a trust-based operation designed to quickly pay claims from legitimate doctors and medical suppliers. A veteran Justice Department prosecutor tells NBC News that if a person stole a million dollars from Medicare through false-billing schemes a decade ago, it was considered a major case. These days, he said, it's not uncommon for individual fraud cases to involve $30 million to $50 million or more. MUCH MORE

Based on my research, 60 Billion Dollars per year is a conservative figure for Medicare fraud, and that doesn't account for the massive Medicaid fraud that varies from state to state. In Florida, which I'll quote as an example, adds countless millions/billions of dollars to the 60 Billion that is already suspected, and when you add in the costs of Medicaid fraud, it's possible that the 60 Billion Dollar figure alleged on Medicare could rise to over a Hundred Billion Dollars of fraud alone on a national basis:

Alex Sink blames Bill McCollum for Medicaid fraud problem BY MARY ELLEN KLAS AND MARC CAPUTO Herald/Times Tallahassee Bureau

TALLAHASSEE -- As Florida hemorrhages as much as $3.2 billion in Medicaid fraud a year, Chief Financial Officer Alex Sink proposed reforms Thursday and pinned much of the blame for the problem on her political opponent, Attorney General Bill McCollum.

Sink, a Democrat running for governor, said that since McCollum took office, the number of Medicaid fraud cases opened has dropped from 727 in 2004-05 to 372 in 2008-09. Florida has the second highest number of Medicaid recipients in the nation, but ranks 39th in convictions per person in its fraud unit.

"This is not a new problem but nobody is focused on it or paying attention to it," Sink said. "Every time I go to South Florida, I hear about some fly-by-night company who's billing the state for a Cadillac wheelchair and they're providing the Ford version and pocketing the difference."

McCollum, a Republican seeking his party's nomination for governor, agrees there is room for improvement -- but he places the blame on the federal government. In two letters to U.S. Health and Human Services Secretary Kathleen Sebelius in the past year, he noted that a 1992 federal rule prohibits the state from screening Medicaid claims to look for a pattern of fraud. He asked Sebelius to waive the rule so his department could work with the agency that administers Medicaid, the Agency for Health Care Administration, to ferret out corruption. MUCH MORE

When you factor in the other 49 states, the overall Medicaid fraud could easily add another 40 to 80 Billion Dollars of fraud per year and even using a conservative figure, we're likely looking at a bare minimum of 120 Billions Dollars of fraud per year a figure that if cut by 75 to 80 percent, could easily fund most, if not all of the taxpayer costs of implementing comprehensive health-care reform.

For the sake of argument, look at what the "War on Drugs" cost the taxpayer's per year and these are costs that continue to rise; furthermore, there is little money that is recovered by the government to pay for this "War," and like health-care costs, the War on Drugs is increasing on a yearly basis:

Economic Consequences of the War on Drugs

Compiled by Anonymous, Drug Policy Alliance. 2002.

How much does the drug war cost American taxpayers?

$40 billion per year and climbing. In 2000, the National Drug Control budget exceeds $18 billion (1) and the states will spend upwards of $20 billion more. (2) This is a dramatic increase since 1980, when federal spending was roughly $1 billion and state spending just a few times that. (3) Between FY1991 and FY2000 more than $140 billion (4) has been spent at the federal level to curtail drug abuse, yet drugs remain cheap, easy to obtain and with higher purity levels than before the war on drugs was initiated.

What competes with the drug war for budget money?

Education. Because prisons and universities generally occupy the portion of a state's budget that is neither mandated by federal requirements nor driven by population, they often must "fight it out" for funding. As state governments sink millions into corrections to house America's exploding population of incarcerated drug law violators now nearly 500,000 nationally (5) education loses.

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My Bio is as varied as my life. In 2012, my twin sons murdered a Journalist in Pensacola, Fl., for 100K worth of "Magic The Gathering" playing cards and buried the body in my backyard. I was once a regular writer here, but PTSD from my son's (more...)

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