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Fraud and Anonymity: The Perils of Medical Care Bureaucracy

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October 8th, 2019   For Immediate Release

Contributor & author: Marilyn M. Singleton, MD, JD, (Oakland-California) board-certified anesthesiologist and President of Association of American Physicians and Surgeons (see bio at bottom of release)

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Preview:

  • After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance
  • Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments.
  • One amoral scheme recruits patients who unknowingly forgo curative treatment options by joining hospice.
  • In 2016 the government paid $160.8 million for drugs that hospice organizations should have paid for from its fixed daily fee. Our tax dollars paid for the drugs twice.
  • One typical victory is a Medicare patient whose neurologist prescribed a drug for his Parkinson’s disease symptoms. The government demanded testing that could not be done because of the patients debilitated condition. Despite a sympathetic ear and supporting research, the government arbiter could only parrot the party line: because the drug was not on the “list,” it was not covered by Medicare. In a fortunate twist of fate, with a Good Rx coupon the patient paid $34 per month cash instead of the drug’s $1,100 per month price with 20 percent patient co-pay that would have been charged through the Medicare Prescription Drug program.

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The high cost of medical care is on the lips of every politician and draining the pocketbooks of most Americans. After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance. Piling on more laws, regulations, and agencies is not the answer.

Anonymity, complexity, and opacity invite shady behavior. Individuals, companies, and patients who defraud the massive federal “health system” would never dream of lifting money from their patients’ wallets or stealing from their doctors’ cash drawer.

The government’s track record does not bode well for imposing more bureaucracy to remedy a problem created by the layers of third-party payer bureaucracy. Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments. By contrast the typical private business loses 5 percent of its revenues to fraud. Unfortunately, since its inception in March 2007, the Medicare Strike Force has recouped less than $2 billion per year in misappropriated funds. More

There’s No Place Like Home…Especially if they can take yours!

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Marti Oakley

 

Medicare Advantage: Only an advantage for those glorious “stakeholders”

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“It isn’t the patients who are bankrupting Medicare….its the service providers on all levels. If the states and insurance companies need to “recapture” their expenses…why not start with those who are gaming the system?”

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According to the US Census Bureau, annual home ownership rates between 1982 and 2017 shows the population of those 65 or older represented just over 80% of all homes owned. This statistic has made the elderly prime targets for estate theft by predatory guardians and attorneys, and now under Medicare Advantage, the state/insurance companies can attack the estate because for some reason they have to be able to recapture the costs of long term care that you financed to begin with.

Now, ask yourself why, after investing in Social Security and Medicare over your lifetime, and….having to pay in most cases exorbitant premiums each and every month once you retire, along with co-pays, deductibles and a host of non-covered services, what you could possibly owe to the state or the insurance company?

But under Medicare Advantage, the combining of Medicare and Medicaid, after you having invested a portion of your earnings over your working lifetime, paid premiums, co-pays, deductibles and paid taxes to support these healthcare programs, these “stakeholders”, the [state/insurance company] must recapture the costs associated with long term care you might have needed, once you pass away.

Now think about this. You worked all your life and invested in Social Security and Medicare. You paid income tax every year which helped pay for medical care for the poor called Medicaid. You bought your home and have been assessed property taxes every year just for doing so, and continue to pay property taxes while you remain there, and long after the mortgage has been paid off. If you hadn’t paid those property taxes they would have already taken your property from you!

Currently, the bills in each state covering this “recapture”, prohibit the state from seizing property if there is a surviving spouse living in or on the property. But once the surviving spouse dies or are themselves put into long term care, the state/insurance company can attack the estate in order to recover those costs. Even if there is joint tenancy or co-ownership of property by those who are not otherwise responsible for, or legally bound to the deceased, the state/insurance company has first rights to the assets. And this recapture takes place before any inheritance can be received by the beneficiaries of the estate. Of course there is no intention of anything to remain for heirs. More

Medicare Advantage Money Grab Fraud and billing mistakes cost Medicare — and taxpayers — tens of billions last year

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Congressional auditor said federal health officials need to crack down on billing errors by insurers

By Fred Schulte

 Updated:

Federal health officials made more than $16 billion in improper payments to private Medicare Advantage health plans last year and need to crack down on billing errors by the insurers, a top congressional auditor testified Wednesday.

James Cosgrove, who directs health care reviews for the Government Accountability Office, told the House Ways and Means oversight subcommittee that the Medicare Advantage improper payment rate was 10 percent in 2016, which comes to $16.2 billion.

Adding in the overpayments for standard Medicare programs, the tally for last year approaches $60 billion — which is almost twice as much as the National Institutes of Health spends on medical research each year.

“Fundamental changes are necessary” to improve how the federal Centers for Medicare and Medicaid Services ferrets out billing mistakes and recoups overpayments from health insurers, he said.

Medicare serves about 56 million people, both those 65 and older and disabled people of any age. About 19 million have chosen to enroll in Medicare Advantage plans as an alternative to standard Medicare.

Federal officials predict the Medicare Advantage option will grow further as massive numbers of baby boomers retire in coming years.

Standard Medicare has a similar problem making accurate payments to doctors, hospitals and other health care providers, according to statistics presented at the hearing. Standard Medicare’s payment error rate was cited at 11 percent, or $41 billion for 2016.

Last week, Attorney General Jeff Sessions announced the arrest of 412 people, some 100 doctors among them, in a scattershot of health care fraud schemes that allegedly ripped off the government for about $1.3 billion, mostly from Medicare.

CMS official Jonathan Morse said that the “largest contributors” to billing mistakes in standard Medicare were claims from home health care and inpatient rehabilitation facilities.

Some lawmakers appeared frustrated that CMS cannot say for sure how much of the “improper payments” in both Medicare options are caused by fraud. The agency uses the term broadly to cover billing fraud, waste and abuse, as well as simply overcharges and underpayments.

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In case you didn’t understand the first time: Social Security is not an “entitlement” program

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strip bannernew-logo25Marti Oakley

Reposted from 2011….and here we are again with another administration that will refuse to deal with the real issues with medicare and social security….the absolute fraud that is perpetrated by the medical, pharmaceuticals and elder services industries costing medicare 20-60 billion annually.
“One way or the other, the elderly in this country will be cleansed from society. In the meantime, every dime that can be squeezed and wrenched out of our existence for any reason whatsoever will continue. And MSM along with government hacks will continue to portray the elderly as receiving “entitlements”, “free rides at the expense of the country”.

Never once will they admit the problem isn’t with the elderly, it is with those who exploit the elderly.”

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It is alarming to hear not only younger members of the country, but also some middle aged members, medical professionals and others, referring to Medicare as some kind of free, gravy train medical insurance that seniors don’t have to pay for. Are people really that ignorant of how this system works?

After paying into Social Security and Medicare for decades, those who receive medicare must also now pay a premium every month for this insurance. These premiums can range from a few hundred dollars a month, to several hundred. Married couples pay individual premiums which can amount to $700.00 per month or more, combined on average. These premiums are deducted from their Social Security checks; neither the government, nor taxpayers, pay this premium.

Then there is that handy-dandy “donut hole” where Medicare pays nothing. This was a huge gift to the insurance companies who whined about not getting a piece of the Medicare pie. From approximately the $2500.00 to $5000.00 costs of care, Medicare pays for nothing. Ta DA! We got your GAP insurance plan which will cost you another $200.00 per month at least. This will cover the costs incurred in the hole. Of course the insurance companies have no plans to make good on these GAP policies, so getting them to pay any percentage of anything is a monumental task.

Then there is the co-pay at your doctors office. Then the co-pay on medications. Then there are the costs of medications your insurance and Medicare don’t/won’t pay for. That comes right out of your pocket!

Now, to add insult to injury, an estimated 20 million illegal aliens will be given “free” healthcare and I have yet to hear the word “entitlement” attached to those benefits.

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What Made You Think Medicare Was “Free” Insurance?

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strip bannernew-logo25Marti Oakley

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It is alarming to hear not only younger members of the country, but also some middle aged members, medical professionals and others, referring to Medicare as some kind of free, gravy train medical insurance that seniors don’t have to pay for. Are people really that ignorant of how this system works?

After paying into Social Security and Medicare for decades, those who 1619098_10202643451221752_1414455253_nreceive medicare must also now pay a premium every month for this insurance. These premiums can range from a few hundred dollars a month, to several hundred. Married couples pay individual premiums which can amount to $700.00 per month or more, combined on average. These premiums are deducted from their Social Security checks; neither the government, nor taxpayers, pay this premium.

Then there is that handy-dandy “donut hole” where Medicare pays nothing. This was a huge gift to the insurance companies who whined about not getting a piece of the Medicare pie. From approximately the $2500.00 to $5000.00 costs of care, Medicare pays for nothing. Ta DA! We got your GAP insurance plan which will cost you another $200.00 per month at least. This will cover the costs incurred in the hole. Of course the insurance companies have no plans to make good on these GAP policies, so getting them to pay any percentage of anything is a monumental task.

Then there is the co-pay at your doctors office. Then the co-pay on medications. Then there are the costs of medications your insurance and Medicare don’t/won’t pay for. That comes right out of your pocket!

Now, to add insult to injury, an estimated 20 million illegal aliens will be given “free” healthcare and I have yet to hear the word “entitlement” attached to those benefits.

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Florida Nursing Home Owner Shield: FL bill 670 a clear violation of federal statute

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new-logo25Marti Oakley

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The Florida House and Senate recently passed a clearly protectionist bill. Fl 670, meant to shield the owners, investors, managers and other employees and individuals from liability for their failure to protect, and to ensure the well-being and rights of home residents, is a clear violation of federal code regarding these same individuals.

Rick Scott, Florida governor and holder of the largest Medicare Fraud Scam on record, dutifully signed this bill into law knowing full well that the abuse, neglect and deprivation of individual rights of nursing home residents would explode as a result.

Scott, apparently not remotely concerned with what is an obvious conflict of interest, or, against the best interests of nursing home residents, signed FL 670 into law.  This despite his active construction of the largest Medicare scams in US history.

10308126_655703157817352_3150440186206186545_nMiami officials exposed the fraud in June of 2009. Five states were involved and several fake businesses were found operating with the intent to defraud Medicare and Medicare Advantage for non-existent drugs and treatments for cancer and HIV. Scott, and seven other defendants were identified in the scam.

Guess how much time any one of them served for this fraud and theft? If you guessed “0“, you would be correct. Instead of going to prison for grand larceny, theft by deception or any other relevant charge, they paid 1.7 billion in fines and settlement and got a “get out of jail for 1.7 billion” pass.  Of course, we can find no evidence that the fine was actually ever paid in part or full.  More

The Emperor Has No Clue

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new-logo25By Marilyn M. Singleton, M.D., J.D.,

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When President Obama hawks the wonders of the misnamed  Patient Protection and Affordable Care Act, I’m reminded of those “As Seen on  TV” products.

True believers ridiculed critics of the Independent  Payment Advisory Board and its unchecked power to ration health care. They were  impressed by the $575 billion cut to Medicare, although lower payments lead  physicians to accept fewer Medicare patients. They cheered because 11 million  Americans will be added to the Medicaid rolls over the next ten years. While  Medicaid looks like is a good deal with its low co-pays, provider payments are  so low that only one-third of physicians accept new Medicaid  patients.

True believers scoffed at claims of loss of privacy.  After the NSA snooping revelations, a Pew survey revealed that 70 percent of  Americans believe the government is using data for purposes other than fighting  terrorism. Not only could unethical employees misuse health and financial  information, the health “Data Hub” can be shared among seven federal agencies  for ill-defined “routine uses.” According to a former HHS general counsel, the  federal government’s computer program for insurance exchanges lacks privacy  safeguards and could expose applicants to identity theft.

President Obama has repeatedly promised that “if you  like your health care plan, you can keep it.” Even his Praetorian Guard has now  defected. The National Treasury Employees Union—which represents the IRS folks  who are ultimately in charge of ObamaCare—does not want its members to be  “pushed out” of the Federal Employees Health Benefits Program and into the  insurance exchanges. More

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