Medicare Fraud
You always hear that there's a lot of fraud in the medicare program, and I wondered, what is that concept based on? Is that true? So, I decided to do some quick research. I found this neat little page by the IRS with examples of healthcare fraud investigations for 2010 link.
Some things you'll notice is that a lot of the examples involve fraud on the part of doctors. There is some fraud on the part of patients, where in one case a fraudulent clinic was established where people with insurance got a cut for signing in and claiming to get expensive care and not getting any treatment. Some of the fraud has to do with getting prescription drugs for re-sale.
What you'll notice is completely absent from any of the examples is people fraudulently getting on medicare. Now, I'm not saying there weren't any examples of that. This is a subset of their total fraud investigations, not the complete list and they were probably mainly using examples that cost a lot. But I think it's interesting that none of the examples are people who got onto medicare and were then shown to not have reason to be on it. Medicare is the form of health insurance people get by being on disability, so it isn't just something people get for being a certain age.
I think when people talk about medicare fraud, there tends to be this notion that it is some of the people on it who are primarily responsible for taking advantage of it. But a lot of the cases seem to show that that isn't necessarily the case. In many situations, I suspect the doctors probably mislead the patients as well or the patients didn't understand the billing. People with disabilities and the elderly are not generally the best group for carefully cross-checking records to make sure everything adds up. And if your doctor is lying to you about whether or not you need a particular diagnostic exam, there isn't really that much you can do about it. Especially when getting a second opinion is neither easy nor free. And if the paperwork lists a similar sounding diagnostic test, it's highly unlikely you'll have any clue it's not the one you actually were given.
Admittedly, the case of writing prescriptions for addicts for a fee does involve the patients as well, but I would consider a doctor enabling an addiction like that rather than trying to help with the medical problem to be more a matter of mistreatment of the patient. Some people might view that one differently.
I also find it sad when people who can make an honest living decide to do harmful and dishonest things. These doctors probably did not need to use fraud to meet their needs. They likely could have managed reasonably well by simply being honest doctors. I have more understanding for people who resort to crime out of necessity. If you can afford to be a decent person, it's really a much better thing to have than a really new, flashy car.
Some things you'll notice is that a lot of the examples involve fraud on the part of doctors. There is some fraud on the part of patients, where in one case a fraudulent clinic was established where people with insurance got a cut for signing in and claiming to get expensive care and not getting any treatment. Some of the fraud has to do with getting prescription drugs for re-sale.
What you'll notice is completely absent from any of the examples is people fraudulently getting on medicare. Now, I'm not saying there weren't any examples of that. This is a subset of their total fraud investigations, not the complete list and they were probably mainly using examples that cost a lot. But I think it's interesting that none of the examples are people who got onto medicare and were then shown to not have reason to be on it. Medicare is the form of health insurance people get by being on disability, so it isn't just something people get for being a certain age.
I think when people talk about medicare fraud, there tends to be this notion that it is some of the people on it who are primarily responsible for taking advantage of it. But a lot of the cases seem to show that that isn't necessarily the case. In many situations, I suspect the doctors probably mislead the patients as well or the patients didn't understand the billing. People with disabilities and the elderly are not generally the best group for carefully cross-checking records to make sure everything adds up. And if your doctor is lying to you about whether or not you need a particular diagnostic exam, there isn't really that much you can do about it. Especially when getting a second opinion is neither easy nor free. And if the paperwork lists a similar sounding diagnostic test, it's highly unlikely you'll have any clue it's not the one you actually were given.
Admittedly, the case of writing prescriptions for addicts for a fee does involve the patients as well, but I would consider a doctor enabling an addiction like that rather than trying to help with the medical problem to be more a matter of mistreatment of the patient. Some people might view that one differently.
I also find it sad when people who can make an honest living decide to do harmful and dishonest things. These doctors probably did not need to use fraud to meet their needs. They likely could have managed reasonably well by simply being honest doctors. I have more understanding for people who resort to crime out of necessity. If you can afford to be a decent person, it's really a much better thing to have than a really new, flashy car.