Quest for Answers

Quest to Find Answers in Cost Savings with Government Controlled Healthcare

To all those who say that health care reform with the “public option” is the way to reduce medical cost through competitiveness and better controls in the health care marketplace, I say bunk!  The sad part is; those who want the “public option” to offer more government control on health care, coverage for all with better savings, better quality and on and on, can’t show historically how that is possible.  

The “programs” implemented by our government have never stayed with in the beginning estimates of budget.  In fact, their ending costs have gone as high as 10 times the initially projected cost.  I would love for anyone to find me wrong!  Please tell the American, realistically, how this can be done?

“With cost savings through reduction of waste, fraud, and abuse in the Medicare system being offered as a key funding source for health care reform currently under consideration on Capitol Hill, eliminating this corruption could require Medicare to adopt private-sector reforms, “ says Thomas Cheplick, with The Heartland Institute. 

The proposal, authored by Sen. Max Baucus (D-MT), currently pending in the Senate relies on such reductions of more than $400 billion in funding over the coming decade.

“Officials estimate that Medicare is annually cheated out of some $60 billion in improper claims payments—an eighth of its entire budget,” said Kevin Wrege, regional state affairs director for the Council for Affordable Health Insurance in Alexandria, Virginia.

Private Firms Can Do Better

Fraud is rampant and unchecked throughout the Medicare system, while private carriers do a much better job of preventing it.

“Private carriers spend a lot on efforts [to prevent fraud], raising their administrative expenses in the process,” stated Wrege.  “By contrast, the Medicare program does not regularly review bills for accuracy and to prevent fraud.”

Medicare typically pays claims in full, and the Department of Health and Human Services’ Office of Inspector General (OIG) operates as a post-claim payment cop, flagging and investigating only those that appear suspicious.

“Recovered funds, if any, are often only a fraction of the often millions of dollars taken,” Wrege added.

Scrutiny Advocated

Many Medicare abuses happen in the market for durable medical equipment (DME), such as wheelchairs and oxygen equipment. A draft OIG audit released in August 2008 flagged almost a third of the 2006 DME claims, as having been improperly reimbursed.

“A July report by the Government Accountability Office found that Medicare paid as much as $92 million since 2000 for equipment purportedly prescribed by doctors who were dead,” said Wrege. “Claimants have submitted counterfeit documents, forged doctors’ signatures, and filed bills on behalf of patients who were dead or had never been seen by the prescribing physician.”

In 2008 a single Florida businessman was convicted of submitting more than $5.5 million in fake Medicare claims. He had operated for months, using some of the money to purchase a Rolls-Royce, despite giving the agency an address that was actually a utility closet.

For more information…

“Medicare’s Hidden Administrative Costs,” Council for Affordable Health Insurance: http://www.heartland.org/policybot/results/26241/

“Improper Payments: Responses to Posthearing Questions,” Government Accountability Office: http://www.heartland.org/policybot/results/26242/

“Medical Review of Claims for the Fiscal Year 2006 Comprehensive Error Rate,” Office of Inspector General, U.S. Department of Health and Human Services: http://www.heartland.org/policybot/results/26243/