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View Diary: White House shoots down House Republican proposal on fiscal cliff (135 comments)

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  •  Cut Medicare fraud,not Medicare (4+ / 0-)
    Recommended by:
    greenbell, Metalgirl, eps62, Australian2

    I say about 60 billion dollar a year is payed too people in  the  Medical community ,claim that are  fraud , make penalities for  fraud  as punitive as they can be,too discourage  fraud

    •  So the new spin frame is "Medicare savings" (0+ / 0-)

      Who are they going to sell that to?  Oh, I know.  I can hear the "lesser evil" argument coming.....

      •  14 Billion a year in 2011 to private health (2+ / 0-)
        Recommended by:
        eps62, Constantly Amazed

        insurance company in subsidies by the US Government for those who offer Medicare Advantage or Medicare Part D.  

        These subsidies were originally offered to encourage private health insurance companies to participate in offering MA to this high risk pool of retirees or seniors.  The belief was that once private health insurance got involved, they could provide "medicare" at a more competitive cost than based free market nonsense.

        The Medicare Advantage program costs 12% more to operate than real Medicare, because of that darned Profit + non-government executive salaries + government subsidies means that the only "advantage" in Medicare Advantage is really for the private insurance companies profit margin.

        This is one place to cut Medicare costs.  

        "Out of Many, One Nation." This is the great promise of the United States of America -9.75 -6.87

        by Uncle Moji on Mon Dec 03, 2012 at 04:16:51 PM PST

        [ Parent ]

      •  You may recall (0+ / 0-)

        that Obamacare posits significant savings in Medicare by pruning administration costs and cutting back on fraud.

        Why not go the whole hog, and let Medicare purchase generic drugs & negotiate for prices with Big Pharma? There's a whole lotta savings right there.

    •  I need to write a diary on this... (1+ / 0-)
      Recommended by:

      its not as easy as it seems. Medicare rules on medical necessity and general compliance have been a big focus the past few years, and these are not easy to understand. The ambulance company I work for has been slapped by the feds a few times already for improperly billing medicare. Education has gotten better, but its putting the burden on front-line healthcare workers to do the job of the billing department. By law, I can't deny care, but if I provide said care that is "medically unnecessary" per medicare's rules, the patient gets stuck with the bill.

      In the work that I do, this only applies when a healthcare facility (say, a skilled nursing home) requests an ambulance for one of their residents. In order to document the medical necessity for medicare to pay for the transport, I have to determine:

      1) Is the necessary treatment for the patient's condition a service the sending facility can provide themselves?
      2) Does the condition require hospitalization, or can the treatment be provided by an out-patient facility?
      3) Is the situation immediate or emergent enough that alternate transportation cannot be made in a timely manner?
      4) If the condition can be treated by an out-patient facility, OR the condition is not an emergency, does the patient have some other condition such that they cannot be transported by wheel chair or require monitoring by a skilled healthcare provider?

      All of this has to be extensively documented. Theoretically, its the sending facility that should have the burden of making the proper arrangements, but they don't. Why not? Quite simply, medicare will refuse to reimburse the ambulance and the hospital for medically unnecessary transports. The nursing home still gets paid as long as their room is held, and its a lot easier to call 911 than to arrange a wheel chair van and an out-patient appointment.

      It would probably require legislation, but the simple fix would be to hold the sending facility responsible for ALL costs associated with medically unnecessary transports, but as usual, these unpaid bills are just absorbed by the rest of us.

      That's just one aspect of "fraud." Yes, it gets called that, and all the compliance bullshit I have to go through every year deals exclusively with this due to consent decrees and settlements with the feds over these very same issues. The wrong people are being held accountable, and due to that, bills just get sent to the seniors themselves and ultimately just get written off.

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