Fighting Fraud in Medicare drug program won't be easy, experts say (KR)

[Up2Late]

(For all the LIHOP people, here's a bone: "...Medicare has identified 33 types of financial fraud that are possible in the program...")

Posted on Fri, Oct. 07, 2005

Fighting fraud in Medicare drug program won't be easy, experts say

By Tony Pugh

Knight Ridder Newspapers

WASHINGTON - Medicare's plan to fight fraud in its new prescription drug benefit is drawing skepticism from experts who say the benefit is too complex to monitor properly and leaves too much discretion to the industries that have fleeced government health programs in the past. With taxpayers and Congress still fuming about the drug benefit's 10-year, $720 billion price tag, Medicare officials can ill-afford to let the program cost spiral due to fraud by doctors, pharmacies, drug companies, drug plans and the firms that administer them.

Medicare has identified 33 types of financial fraud that are possible in the program. Some are as simple as over-reporting the number of prescriptions filled or billing for brand-name drugs when generics are dispensed.

Others are harder to detect, such as fraudulently inflating drug prices and soliciting or receiving a kickback, bribe or rebate in exchange for prescribing certain drugs or including them for coverage by drug plans.

In the past, these kinds of schemes have bilked billions of dollars from such federal health programs as Medicaid and Medicare, forcing cuts in services and increasing costs for patients. On Friday, Medicare announced that eight private companies will have the primary task of policing the drug program.

<http://www.realcities.com/mld/krwashington/news/nation/12846722.htm>
(more at link above)

[napi21]

1. Heard a nurse on WJ this morning talking about fraud in medicare

under the current plan. Said she worked in many different health care institutions across the state of Tx. over 40 years. She turned in one of them and the Feds. fined them and shut them down. She said the Feds claim there is about 39% fraud in the current program, but she believes it to be closer to 79%!

All that, and they haven't even begun the new drug program!!!!

When she turned that institution in, there were 2 Medicare investigators for the whole State of Tx. and this admin. has reduced the number of investigators by half nationwide!

From what I can tell, most of the fraud is not committed by the patients, but by the Doctors and heads/owners of the institutions!

Sounds to me like a talking point for the Dems to push! Demand MANY MORE investigators be hired. Even if the Feds are right at their 39% fraud. If fraud could be reduced to -5%, it could save the whole program!!!!

[Up2Late]

2. Yup, it's just like with the IRS, they keep cutting the funding so...

...the IRS has to cut their auditors, and with fewer auditors the Mega-Corporations can avoid paying any taxes. I doubt I have to tell you what the Mega-Corps do with some of that extra money.

[SharonAnn]

3. Yep, it's the GOP owners and health care owners committing fraud.

It's been that way in every case I've seen since I've been watchin (over the last 10-12 years).

Especially true in the case of HCA, the Frist family business, which paid $1.7 BILLION dollars in Medicare fraud cases between 2000 and 2005.