Reporting Medicare/Medicaid Abuse

[music2doc]

Sadly, I have to agree with you; most if not all social welfare programs are dismal failures, mostly owing to their centrally planned nature, but also due to a problem to which you alluded earlier: corporatism. There is no way to climb out of poverty if we allow and even encourage employers to remove the rungs from the bottom of the ladder, and by this I mean opening factories abroad without consequence or taxation, quashing unions at home, and trashing the environment to the point where the health of those living near factories, mines, and oil/gas extraction sites is severely jeopardized.

Obviously the solution can't be simply taxing profits, since this does nothing to discourage this behavior nor does it help the abused (although it at least would help with our budget). Still, I honestly think we have a lot of room for improvement that doesn't involve outright welfare. Things like power and transportation infrastructure, medical and scientific research, and the creation of public universities all have universal and relatively cheap benefits for everyone. Still, I wouldn't be so quick to dismiss giving at least some luxuries to the poor when there are children in the household. The effects of living without these luxuries as a child are demonstrably negative.

Sure, absolutely agree children in poor households should be afforded some "luxury" HOWEVER, this should NOT include things like cable TV, internet, computer games, etc. Those are generally harmful to a child's development for a number of reasons. Reasonable luxuries would include things that get the kids outside. They might include creating undeveloped/reserve areas in the middle of impoverished neighborhoods where the kids can play (i.e., be kids and do such things as build tree houses or play sports, etc.) and providing options for free or discount passes to local recreational facilities. Many YMCAs have this as a mission and actually do provide sliding scale or free memberships to such individuals. Government funding diverted from unnecessary* food stamps, medical care, etc. to the development of such facilities would be a great idea.


*Unnecessary being defined as that going to people who could otherwise afford some or all of their minimal food, medical care, etc. necessary for survival if they were working at their maximum potential and did not spend that money on optional goods and services

---

Members don't see this ad.

 

[rbnsafsadgf]

Oh if you are going to use the argument about the constitution, then where does it say anyone has the right to another persons money?

The health and welfare of its population is the fundamental concern of a nation-state. More of a natural law argument than a constitutional one.

Has anyone here ever dealt with reporting patients who repeatedly (and expensively) abuse the Medicaid/Medicare system? I probably see at least 10 patients/wk who are obviously abusing the system (of the 100 or so I personally see each week, about 60% of whom are Medicare or Medicaid). For instance, just recently I had a patient (<64 y/o) on Medicare and Medicaid due to a supposed physical disability, yet somehow he managed to supplement his government pay-outs as a professional wrestler. He did not appear to have any other disability (i.e., his only disability was, shall we say, apparently nonexistent). Now, tell me how this is at all appropriate? Yet, I see hundreds of these patients each year who apparently defrauded and deceived their way into Medicare/Medicaid as well as those who, while marginally eligible, have milked these "free" services for all they're worth (e.g., by demanding unnecessary and costly tests of physicians and making -- and then following through with -- threats to sue whenever they don't get their way).

Please think about what the differences are between abuse, ignorance, and nursing the system. Also think about those on so-called private insurance who are doing the same thing and make sure that you are applying a similar standard.

Many real disabilities are not obviously apparent.

If you want to advocate for efficient use of public health care dollars, advocate for expanded, universal access. Read up on the ideas behind the NHS's NICE and the Oregon Health Plan.

You will see plenty of ****. Don't take out your political beliefs on patients of yours. Advocate for system level change.

Also, physicians deal with "demanding" pts often and part of their job is to order only what is needed.

 

[rbnsafsadgf]

Sadly, I have to agree with you; most if not all social welfare programs are dismal failures, mostly owing to their centrally planned nature

Ummm, yeah, no.

Please read up on the health systems of most other Western countries. Look at the costs and the outcomes. You will also notice that these health systems are "welfare programs"

Please read up on the public health in the last 150 years, the Earned Income Tax Credit, Head Start, the Pell Grant, the GI Bill and many other things that are "welfare programs."

 

[rbnsafsadgf]

One would think there are ways for healthcare workers to make such reports as we are the front line. Further, what are the HIPAA implications of making such a report?

Also, to answer your original question, Medicaid is administered by the state, so call up your local state DHS/welfare office and ask them and they will have an answer for you. I have little clue about Medicare "fraud," as you call it, but it is generally harder to get onto with the non-age eligibility options, so I suspect that those people have been vetted to a greater degree.

 

[music2doc]

Please think about what the differences are between abuse, ignorance, and nursing the system. Also think about those on so-called private insurance who are doing the same thing and make sure that you are applying a similar standard.

Of course. At the same time, most private insurers have mechanisms in place to make this a bit less feasible for their customers (our patients) -- e.g., copays and coinsurance -- unlike Medicaid (which costs the pt nothing).

Many real disabilities are not obvious apparent.

This is true; however, if a disability is not readily apparent, is it likely it would prevent the person from holding down an entry-level job as, say, a telemarketer or fast food clerk?

If you want to advocate for efficient use of public health care dollars, advocate for expanded, universal access. Read up on the ideas behind the NHS's NICE and the Oregon Health Plan.

How does this help the issue if patients are given no requirement to pay? I would advocate for public health dollars going to a limited preventive program, heavy tort reform, abolishment of an expectation of "definitive care" for patients (without paying the astronomical prices it costs to provide that level of diagnostic accuracy many cases), etc.

You will see plenty of ****. Don't take out your political beliefs on patients of yours. Advocate for system level change.

Absolutely, but at this point in time, I have little ability to affect that type of system level change. As long as I am nothing but a cog in the system, I will not have that kind of influence. Perhaps as a physician, my influence will increase. (One would hope.) But until then, there is little I can do at that level, unfortunately.

Also, physicians deal of "demanding" pts often and part of their job is to order only what is needed.

This is theoretically true, but do you have any idea how often physicians end up ordering things because the patient makes threats? What if this patient ends up being that 1 in 100,000 case and dies or is harmed as a result of not doing a $10,000 test that is medically dubious but demanded by the pt based on what he read on Web MD? The problem is that the physician is not protected by "good faith" AFAIK. My dad is a physician. He has never been successfully sued and is an extremely successful physician. About 15 years ago, he had a woman actually bring a lawsuit against him because he fired a pt who had demanded some $100,000 in unnecessary tests. He was around her 30th doc to be sued. Technically, he still sits on a list of physicians she is bringing suit against. While the judge called him and literally told him "Dr. XYZ, your patient, ABC, has brought a lawsuit against you... however, it is unlikely it will go to court as she has so many other lawsuits against physicians ahead of you in line, neither you nor she will likely be alive by the time your case actually comes up, I wanted to let you know the suit been filed," the knowledge of being sued is stressful. I think sometimes we forget that as pre-medical and medical students. It's not as easy to turn down that demanding patient as you seem to imply here.

 

[music2doc]

Also, to answer your original question, Medicaid is administered by the state, so call up your local state DHS/welfare office and ask them and they will have an answer for you. I have little clue about Medicare "fraud," as you call it, but it is generally harder to get onto with the non-age eligibility options, so I suspect that those people have been vetted to a greater degree.

Thanks. I am more concerned with the Medicaid patients overall than the Medicare fraud as it seems the former are generally the ones I see abusing the system most. The Medicare patients who come in unnecessarily are often, as you implied, simply ignorant. In their cases, it might be best to focus on educating the public. In the Medicaid patients' cases, more aggressive action might be necessary.

 

[link2swim06]

Ummm, yeah, no.

Please read up on the health systems of most other Western countries. Look at the costs and the outcomes. You will also notice that these health systems are "welfare programs"

Please read up on the public health in the last 150 years, the Earned Income Tax Credit, Head Start, the Pell Grant, the GI Bill and many other things that are "welfare programs."

1. Other western countries have a VERY different climate than the US. First off people aren't trying to be healthy in the US. This is obvious with diet and exercise choices. In Europe, you dont have half the country with 2 chronic diseases and the majority of the population obese. The outcome is different because their attitude is 180 degrees from ours.

2. The bolded words aren't what people generally talk about when they mean welfare. The word welfare can really be quite broader than that if you trace it back to its mean in the constitution than even you are using. Those things you listed are mainly education related but I think the argument at hand are those programs where people actually are given something physically. Be it food, cash, healthcare, housing, whatever... These programs are appropriate for people in dire circumstances, but thats not the condition of most of our poor.

 

[Cornu Ammonis]

Ummm, yeah, no.

Please read up on the health systems of most other Western countries. Look at the costs and the outcomes. You will also notice that these health systems are "welfare programs"

Please read up on the public health in the last 150 years, the Earned Income Tax Credit, Head Start, the Pell Grant, the GI Bill and many other things that are "welfare programs."

I don't need to read up on any of those things, since I've already done so and I regularly advocate for their continuance and for the adoption of single-payer healthcare. I take issue with calling things like the GI bill, which requires a commitment from the recipient, or a single-payer system that covers the entire population 'welfare.' Under that definition, social security and the post office would be welfare, but I suppose I shouldn't begrudge you your choice of words.

 

[Cornu Ammonis]

1. Other western countries have a VERY different climate than the US. First off people aren't trying to be healthy in the US. This is obvious with diet and exercise choices. In Europe, you dont have half the country with 2 chronic diseases and the majority of the population obese. The outcome is different because their attitude is 180 degrees from ours.

This is entirely untrue. Countries like the United Kingdom and Germany are plenty fat, and the rest of Europe is fattening up as we speak. Just as was the case with economic liberalization, we're at the forefront of unhealthy living and Europe is not far behind.

 

[link2swim06]

This is entirely untrue. Countries like the United Kingdom and Germany are plenty fat, and the rest of Europe is fattening up as we speak. Just as was the case with economic liberalization, we're at the forefront of unhealthy living and Europe is not far behind.

They are catching up, but its still much higher in the US... http://www.nationmaster.com/graph/hea_obe-health-obesity which translates to even higher costs than other countries would have to pay per person.

Apart from popular media, fully socialized medicine doesn't always improve the outcome
http://www.ncpa.org/pub/ba649

We certainly already have a quasi-socialized medicine in this country but I dont think fully socializing medicine is going to be attributable to better outcomes like the previous poster mentions.

 

[rbnsafsadgf]

2. The bolded words aren't what people generally talk about when they mean welfare.

Yeah, because I am using the word in the way that educated folks use it.

http://thesocietypages.org/socimages/2011/12/28/hidden-beneficiaries-of-federal-programs/

By your standards, Medcaid isn't welfare either.

 

[link2swim06]

Yeah, because I am using the word in the way that educated folks use it.

http://thesocietypages.org/socimages/2011/12/28/hidden-beneficiaries-of-federal-programs/

By your standards, Medcaid isn't welfare either.

Ok so let me get you argument correct, you are claiming your singular definition of welfare is correct bc you are educated and one link on the internet confirms that......right.

The definition according to the dictionary is "the good fortune, health, happiness, prosperity, etc., of a person, group, or organization; well-being" ... as I am sure you have studied the constitution like the "educated folk" you assert yourself as, you would know the founding father used welfare to mean anything from roads to police to the post office to [insert something the government] does for the people.

Ask someone on the street if they are on welfare...I am guessing those who are on the GI bill arent going to answer yes. People on food stamps probably will answer yes.

Yes they are all social programs, but I am using a common usage of the word.

I mean going to the extreme of your more literal meaning, I could call the post office a welfare program, it helps the prosperity of the people, right?

 

[IMSingular]

Relax- it is only for food, housing & medical. All these factors have risen & min. wage has not. You aren;t paying for anyone's iPhone.

Your duty is to pay taxes & not b!tch.

There are nonptofits that give poor used iPhones and computers etc. In today's envioronment you can't do home work without an internet access or it is not easy to get a job without and access to cell phone.

 

[Cornu Ammonis]

They are catching up, but its still much higher in the US... http://www.nationmaster.com/graph/hea_obe-health-obesity which translates to even higher costs than other countries would have to pay per person.

Apart from popular media, fully socialized medicine doesn't always improve the outcome
http://www.ncpa.org/pub/ba649

We certainly already have a quasi-socialized medicine in this country but I dont think fully socializing medicine is going to be attributable to better outcomes like the previous poster mentions.

The main benefit to socialized or other universal healthcare systems is, in my opinion, not better outcomes but lower costs both to employers and employees. As you've already mentioned, we already have government programs for the very poor and the elderly, but in between there are plenty of people who simply can't afford health insurance and so they can't afford many treatments. Universal health care covers these people and benefits us all in the same way that public school benefits more than just the children who would otherwise receive no education, and it does so with lower administrative costs and without the incentive to cheat its customers.

On top of all this, when the government provides healthcare the cost is decoupled from employment so long as it is funded by income and capital gains taxes rather than payroll taxes; this means hiring new people becomes much cheaper and the burden is only after profits. Because Canada has such a system, there are many cases in which businesses will choose to open factories over the border because a tax on profits is much more bearable than the definite cost of paying for employee health plans whether or not you turn a profit. The ultimate result would be lower unemployment and higher wages, meaning the tax burden would eventually be better spread among the population as it once was even when tax rates on the rich used to be much higher.