Medicare Overpays Due to Sluggish Process

It is no secret that there are some serious issues that need to be addressed regarding Medicare.  Lawmakers are looking for financial solutions, auditing solutions, quality control solutions and other changes to make sure that the Medicare system becomes sound again and is there to support seniors when they need it.

There have been problems with fraudulent and erroneous claims front and center in the news lately.  On top of Medicare paying out billions of dollars that should not have been paid out for claims from phony doctors and patients for phony equipment and services, the Centers for Medicare and Medicaid Services (CMS) has been using their own Medicare officials to do the audits to figure out what types and amounts of fraud were actually perpetrated.

The lawmakers and oversight commissions have come back and stated that the Medicare auditors actually were not the right auditors for the job, were not following the strict guidelines regarding audits and, in the end, needed to be audited themselves because their figures were not accurate.  Without following the correct guidelines, much of the fraud was missed.  In addition, sending someone from their own agency to audit themselves isn’t a real effective or efficient way to find errors or fraud.

Currently, there are more issues that have arisen.  One issue that has created problems for years is the sluggishness of the claims process and the payment process.  Medicare beneficiaries and their medical providers are frustrated as they wait month after month for claims to be paid while expenses pile up, making it hard for everyone involved.

The latest situation – which has cost Medicare more money that it doesn’t have to spare and didn’t need to spend – involves overpayments for medication.  Because the Medicare system is so slow, Medicare missed the opportunity to pay for less expensive generic drugs rather than brand names.  Medicare was so far behind that they did not enter the generic alternatives into their computer systems when they became available, thus paying the higher prices.

One of the main medications, a cancer drug, was paid for at double the generic price because of a two-month delay in entering the new information into the system.  The system had no idea that generics were even available for this particular medication, according to the inspector general’s office.  There are also overpayments for other drugs that have generic counterparts.

With Medicare’s financial woes, they should be at least working faster to save themselves money.  When confronted with the information about the overpayment, Medicare acknowledged that they should input information in a timelier manner so that it will reflect current market prices.

With lawmakers and others trying to save Medicare, it’s time for Medicare to help save itself.

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Billions in Florida Fraud Rocks Medicare

As if there wasn’t enough fraud in the world today – especially in Miami – the FBI has uncovered even more.  This is not your garden variety every day fraud, this fraud has been big business and cost the government and taxpayers billions – yes BILLIONS – of Medicare dollars.

While many honest citizens are working hard to pay billions of dollars for a war and other conflicts that they may or may not agree with, these individuals have stolen money that could help bolster the Medicare system, which is having some serious financial issues, in case they hadn’t heard. 

It brings to mind the old question about whether you would steal from your own parents or grandparents.  Apparently, these fraudsters would.  In fact, not only have they done that, but by taking BILLIONS away from a system that is so badly needed by our most vulnerable citizens, they are also stealing from their own children and grandchildren.  Of course, when you think about it, their parents, grandparents, children and grandchildren may not need the benefits since they will have all the money that was stolen – unless it gets confiscated by the FBI. 

The way this particular scam worked, “patients” were recruited to see particular doctors.  They were paid each time they went to an office visit.  The clinics that these doctors work for then billed Medicare for all sorts of fraudulent services, including AIDS treatment that is not even used any more in the United States. 

Medicare does not combat fraud as effectively or aggressively as private insurance companies do, even though they have received funds to do so.  One of the primary reasons that Medicare is not effective at preventing fraud is that they do not have a system that prevents fraud before money is dispensed.  Without a containment system at the beginning of the claims process, it is impossible to stop fraud because once the money has been paid out, it is much more difficult to get it back – especially because most of the time, the fraudsters have already left the country.

Medicare is a huge agency with an enormous budget and over 44 million people who depend on it.  Fraud costs Medicare over $60 million per year.  Surely there are ways to eliminate at least some of that fraud.  Eliminating even half of it would fix the Medicare budget and the education budget, too.

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