Just another government boondoggle! What's new?

Knowing our government, they are probably paying more to the contractors than they are recovering from the investigations. Of course when you factoring in the government employees who do nothing but 'supervise' the contractors, it gets even worse. Most government employees do not actually do any work, all they do is send the work to the contractors and then try and take credit for the work after it is complete. After all, without their 'supervision' the contractor would never have gotten the job done correctly. (sarcasm intended)

It is ridiculous that they are only recovering 7% of the total fraud they are identifying. The fact that it is taking 6 months to refer cases to law enforcement raises a lot of questions. If you factor in how long it takes before the government spots something wrong and then the time for the investigators to refer it to law enforcement, you are probably looking at a minimum of a year. When you wait that long, you give the perpetrators too much of a chance to cover their tracks or close up shop and move on to the next scam. These scam outfits know how long it will take so they set up corporations, scam the government, and then shut down the company, often by bankrupting it, before law enforcement even gets there or if not, as soon as they catch wind of the investigation. Then law enforcement has nothing to go after, with the company's assets having been liquidated and the scammers having made their money in the huge salaries they took from the company. The companies records are conveniently lost and the people who worked there who may have spotted the fraud going on have moved on and their memories are unreliable and not sufficient for prosecutions without records to back them up. This leaves law enforcement with no hard evidence to prosecute anyone and no money to recover.

So in other words, we need regulation and we need the regulation enforced. This has been so lax for so long like so many things, where to begin?

But conservatives, well they don't believe in regulation. They will argue privatizing everything would be better. Because insurance companies are so benevolent, and private providers are so honest, and the care will be so much better. Not! The fraud is being done by the private providers and this is why Medicare is strained in large part. The insurance companies only care about profit. And both provide service that sucks.

Some things are best left to the private sector. I'm all for the postal service being split up among UPS, FedEx and DHL. I'm even in favor of privatizing education. If education was for-profit and parents had to pay for all of it on their own, you can bet that children would start getting a better education.

But some basic needs, like health care is best left to government. I don't believe this should have ever been a benefit provided by companies. But most of all, health care should be non-profit because it is immoral to profit from illness. So once again, we need smaller government and we need to make cuts. But we need to use a scalpel, and we need to be objective and consider everything including defense spending.

It's easy to fix. Only pay contractors a 10% bounty on recovered money AFTER the money has been actually recovered. And pay whistle blowers 15% tax-free AFTER money is recovered. The idea would be to turn everyone who comes into contact with Medicare/Medicaid scammers into a potential turncoat. Make is so these people can't trust their own mother for fear of being ratted out.

This isn't an Obama problem directly, it is a systemic problem with government. Government is inefficient, ineffective, rife with fraud, abuse of power, crooks, criminals, career porn watchers and systems that are completely mis-managed.

Government unions are partially to blame, keeping senior employees protected even though some if not many are perpetrating crime, and the people inside the system that know what is what and choose to ignore, or are stonewalled by senior lazy management, all add up to a system that is grown way too large, way too unmanageable. and must be rebuilt from the ground up.

We now see headlines nearly every day uncovering federal, state, and local fraud, abuse, mis-management, and criminal activity taking place, costing all of us billions and billions. Government is the problem, not the solution.

Gov. workers who are gauranteed their job just don't care. Go to Motor Vehicle aand you can see this. They only do one thing at a time and very slowly with no extra effort.

I happen to live in ground zero or the Medicare fraud capital of the country, which is Miami. I have given some thought to how we might beat it. Because the shops are usually dummy locations sitting empty or just with the tools of the trade but no personnel. With so many unemployed people in South Florida, I'm sure they could get alot of people who would be more than willing to be placed at every location that has a Medicare billing number and pay them $10/hr. to document every patient that comes through the door and gets to observe every procedure that is done in each office. They would also get to go on all house calls to observe all procedures that are being done for home health care patients. The employees would be rotated on a weekly basis so that the perps wouldn't be able to pay off the workers to look the other way. If they were instrumental in stopping a fraudulent office then they would also get a percentage of all money recovered.

It takes numerous people to be complicit in Medicare fraud beginning with the doctors, on down to the nurses and staff who absolutely are aware of that the fraud is happening and last but not least to all the patients who are being paid off in order to use their Medicare number.

I'm also calling out the Cuban community of South Florida who are responsible for up to 70% of the Medicare fraud that is going on in South Florida.....shame on you! I had spoken at length to a nurse who had worked for a fraudulent clinic for years and knew exactly what was happening but refused to report it because she was making so much money. She is now in jail, thankfully.

The FBI say that they can't keep up with the perps because they merely close up shop and set up a new location. Therefore, if we put a warm body in each location to observe and report anything suspicious, don't you think it would be rather difficult to get away with fraudulent billing for procedures that aren't being done or non-existent patients or an excessive amount of procedures for the same patient.

True Patriot,

You can't get rid of the post office and privatize it. You see the US Constitution mandates a post office (Article 1 Section 8) unlike health care that is no where in it. As for basic needs, I suppose you would support the government providing other more basic needs (non-profit) like food and housing?

Australia just passed a LAW requiring people of WEALTH to PROVE that their wealth came from LEGAL occupations/sources. Other wise the Australian Government seizes the assets. They are going after the people that are driving the expensive vehicles and those that own the expensive homes.

Australia already has on their books a LAW that confiscates the assets of people convicted of crimes..... Plus they seize the vehicles that were used, even if the owner of the vehicle was not involved..... see http://www.adelaidenow.com.au/news/breaking-news/human-rights-being-trampled-in-australia-says-former-wa-premier-geoff-gallop/story-e6frea73-1225842505709

Maybe the USA should use this approach to collect.....

This has been going on since the beginning of time, with politicians on both sides. Are you really that gullible to believe that this is "all because of bush"?

Bush & Cheney are gone. Obooboo is in control and is doing zilch!

Are you in a cave somewhere? Did you read the story? So now I suppose Medicare fraud that happened 5 years ago is also Obama's fault. The name Dud fits you.

Take the investigators that only turned up the low single digit cases, require a refund and fire them to never be hired again as they are part of the fraud.

Seriously? This has been going on since the dawn of man.

Bush and Cheney? Get a new story - only the most partisan idiots are still banging that dead drum.

This has been going on since Medicare and all other government programs have been around. The way to limit fraud is to get the consumer involved with spending their own money.

You think this is bad, wait until ollamacare is in affect.

Hey Ourdickhead, did YOU read the story? I don't think 2009 was 5 years ago, and Obooboo was in charge when this $36 BILLION was scammed!!

Medicare overpayments — they can be anything from a billing error to a flagrant scam — totaled more than $36 billion in 2009, according to the Obama administration.

You are so right and I cringe when people say the president is not doing enough. Jeez rampant fraud this one started in 2005. Gross mismangement of Iraqi rebuilding funds. No bid contracts for Halliburton. Now this program was started by Bush and Cheney and once again Obama has to clean it up.

Can someone tell me when Bush's screwups will all go away. They say he keeps blaming Bush for our troubles; well here is a good example of why he can still blame him. Plus when we kick Halliburton to the curb and prosecute them for the fraud they perpetrated on the USA maybe we'll start to straighten out this mess.

By the way can someome tell me how long it took Reagan to turn the economy around and how long we had 9.8% and higher unemployment? I'll give you a hint it was 12 months and he started from the same position that Obama did and his recession wasn't even this bad! He also didn't have trillions of dollars in debt and a deficit he inherited of over a trillion dollars. So tell me again how great Republicans are at handling our money?

Thanks Ron for your first hand comments about something that IS getting done!

If you remember when Obama was campaigning, he said he would rein in all this waste from all government programs within his first year. And with this we could fund healthcare and protect the deficit from going higher. Granted he has a lot on his plate, but he knew of the two wars and economic downturn long before he took office. Remember he was a Senator. I don't understand why all politicians say they can do so much if they get elected and they never do. The way I see it they all lie to us even before they get in office and get better at the lies from that point forward.

Bear in mind that Obama's attempts at reform have been resisted at every turn by a monolithic Party of Hell No, whose chief political philosopher and spokesman, Rush Limbaugh, openly declared his desire for Obama to fail, no matter at what cost to the nations as a whole.

Sorry, that doesn't fly. The Clown in chief has minions to take care of lesser tasks.

It just isn't a priority. Spending is the main objective in case you haven't noticed.

Lets see how stupid the American public is, spend more money than they have and put the yoke of additional taxes on them.

Its not the american public that is stupid, WE KNOW medicare fraud is going on and WE KNEW Obama WOULD NOT put an end to it as promised. His deficit neutral health care reform was never going to happen, meaning we all knew (except for those drinking the koolaid) it would never be deficit neutral. How is this solved? Well it seems the current administration is going to waste more money by hiring more people to take advantage of the government. Put the blame where it belongs. Oh and how does the party of NO have anything to do with this? In case you hadn't noticed we have a democratic president, congress and house.

And we have the Repuklicons trying to stop everything and block every single thing coming up in congress after yelling they wanted bi-partisan (but only if everyone voted their way).. Are you blind deaf and dumb? Well the last one is obvious...

I don't drink koolaid, and my proof is I never voted for Bush.. we know you did..

If you're ever going to become an actual nurse, take your head out of the sand and look around.

Keep in mind he has had a Democrat congress in charge since 2007. This clown has complete control of our government and has nothing to show for his complete and utter incompetence.

He campaigns 24/7, spends millions monthly polluting our air flying all over the country sputing his lies and utter hatred for all things conservative. He is divisive, speaks without thinking, and has created the biggest racial divide in decades.

This fool couldn't manage a grocery list, let alone a recovery.

Remember, the liar told us if we passed the stimulus, unemployment would not go above 8%. And then a few months later the moron actually admitted gee, this was worse than we thought.

All that education and who's running the country? A tax cheat, a liar, and a band of idiots.

But I hear Spain is nice this time of year. That is, if you can afford $2,000 a night hotel rooms and have Airforce 2 at your disposal. The Europeans are laughing it up at Michelle's expense alright.

The POTUS actually has a couple people working for him -- he doesn't have to do it all himself. He's been in office about 1.5 years, accountability increases with time and the chickens are coming home to roost.

There's no reason Obama didn't get a crackdown on Medicare fraud started by the end of January 2009 and it would have been in place now and already would have saved taxpayers a bunch of money.

However, it appears what he did instead was lump this with Health Care Reform so he could claim "cost savings" by doing something he should have done regardless of if HCR passed. In effect, he held the taxpayer hostage in order to use "creative" accounting to make HCR look better (sort of like a toddler pounding his fists on the floor and holding his breath saying "I'm going to keep breaking the expensive china until I get more XBox time). Improvements in Medicare fraud detection and recovery of ill-gotten claims are no more related to HCR than reducing waste by the Coast Guard is and shouldn't have been linked to HCR at all.

He only has four years to complete the tasks he promised or should do and the time is nearly half up. Yes, he may be reelected, but that should be based on NEW promises, he doesn't get to just keep repromising the same thing because he "didn't get around to delivering it last term" - that's not a very compelling political stance.

Bush was in office for 8+months when 9-11 happened. But YOU LIBS blamed it on him......

The planning, funding, training, and placing the key personnel in the USA for 9-11. Happened during the WJC Administration.

AC Robertson

The reason Bush was at fault for 9-11 was that he DID TAKE ACTION(s), only the wrong one(s). Go read the initial and final 9-11 report, not the Fox News nonsense.

Bush cancelled programs/funding to catch / kill Bin Laden and other covert actions against Al-quadia. That and he was warned (recall the all system's "blinking red" presidential briefing) and choose to ignore. Bush denied multiple requests from FBI / CIA to fund their efforts against radical Islam. Ashcroft's list of top 10 threats did not even have terrorist in them, it was #1 on the Clinton list (again read the 9-11 report, do not quote Fox News or Rush). Recall the Bush / Gore debates. Bush did not believe in a threat from a Rogue State (you can find the reruns on C-SPAN)), he was only interested in funding and preparing for a WWII style 2-front war. You know the kind that generates the most profit for his defense contractor pals.

The initial 9-11 report (still available) tried to "no lay blame" but it documented (undisputed) the efforts taken by Clinton (please do not repeat the Fox News BS) with regards to Al-Quadia including funding a dedicated CIA "desk" (think department) to catch or kill bin-laden, drones missions, negotiations with Pakistan for a joint effort (interrupted by the change in gov't) to attack the terror networks, etc, etc, etc,

Bush took office and cancelled EVERYTHING

Ron-2103390

After releasing the report, Commission Chair Thomas Kean declared that both Presidents Bill Clinton and George W. Bush were "not well served" by the FBI and CIA..

CIA Director Tenet Warns of Imminent al-Qaeda Attack. There was no conclusive, smoking-gun intelligence, but there was such a huge volume of data that an intelligence officer's instinct strongly suggested that something was coming. He did not know when, where or how, but Tenet felt there was too much noise in the intelligence systems. This was 72 days prior to 9-11.

The July 10 meeting between Tenet, Black and Rice went unmentioned in the various reports of investigations into the Sept. 11 attacks, but it stood out in the minds of Tenet and Black as the starkest warning they had given the White House on bin Laden and al-Qaeda. But the Boston Globe reported that "it turns out that the panel was, in fact, told about the meeting, according to the interview transcript and Democratic Commission member Richard Ben-Veniste, who sat in on the interview with Tenet."

Afterward, Tenet looked back on the meeting with Rice as a tremendous lost opportunity to prevent or disrupt the Sept. 11 attacks. Rice could have gotten through to Bush on the threat, but she just didn't get it in time, Tenet thought.

• August 2001: Russian President Vladimir Putin Warns US of Suicide Pilots Training To Attack US Targets [Fox News, 5/17/02]
  The head of Russian intelligence also later states, “We had clearly warned them” on several occasions, but they “did not pay the necessary attention.” [Agence France-Presse, 9/16/01] A Russian newspaper on September 12, 2001, claims, “Russian Intelligence agents know the organizers and executors of these terrorist attacks. More than that, Moscow warned Washington about preparation to these actions a couple of weeks before they happened.” Interestingly, the article claims that at least two of the terrorists were Muslim radicals from Uzbekistan. [Izvestia, 9/12/01]

August 23, 2001: Mossad Reportedly Gives CIA List of 19 Terrorist Living in US Planning An Attack In The Near Future [BBC, 10/2/02]

A coherent plan for covert action against bin Laden was in the pipeline, but it would take 2 some time. In recent closed-door meetings the entire National Security Council apparatus had been considering action against bin Laden, including using a new secret weapon: the Predator unmanned aerial vehicle, or drone, that could fire Hellfire missiles to kill him or his lieutenants. It looked like a possible solution, but there was a raging debate between the CIA and the Pentagon about who would pay for it and who would have authority to shoot.

For further information see http://www.americanhiroshima.com/911warnings.htm

ALL of these WARNINGS centered around OBL and there was a plan in the works to counter this. There was no specific dates or locations, until early September. Less than a week prior to 9-11.

Names of people involved may have been included in the; Russian Intelligence or Massad warning to the CIA, two week prior to 9-11. But this information was not forwarded to the people that could act-on-it. Bush Jr was not in this loop.

I have been unable to find and references to ANY plans or programs concerning 9-11 or OBL that Bush Jr CANCELLED. Where is your reference???

You have provided a very good description of what CMS is doing. Do you work for CMS, or for a hospital preparing for the RAC?

There ar several problems that complicate the CMS rules. Yes, they have been hiring people to audit hospitals and doctors for years already. These people are paid a bounty for what they recover, which means that they often are the ones committing fraud by reporting honest mistakes and even more often simply ruling that some test or treatment should not have been done. A catch phrase they use is that you "knew, or should have known" that a certain test or treatment was not covered by CMS. This is often the argument even when the last 10 patients to undergo the test were approved. Then, payment is not only denied but the doctor is told to pay back treble what he charged in the first place, say $75.00 for every CBC (complete blood count) that he billed at $25.00 each. On top of that, the doctor is told that he can be fined $10,000.00 for each of those blood counts if he decides to contest the findings. If the doctor is brave enough to go to court, he is still not paid for his work until he proves himself innocent (can you say "due process of the law" or "equal protection under the law"). This can take 2 years or more.

The flaw with the "carrot" is that the very sickest people will not have as ready access to medical care. A lot of doctors already send their sickest patients to specialists. A lot more will decide that it is not worth while to treat patients with really bad heart or lung conditions if they are paid the same for treating the less severely ill. So far CMS has painted with such a broad brush that it does not distinquish between a little bit of congestive heart failure and someone who has to sleep sitting up and is on 5 or 6 medicines that barely keep them alive. In fact, now CMS wants to punish hospitals if patients return too soon after being discharged. There are going to be a lot of very sick patients who are turned away or placed on hospice prematurely if this continues, but maybe that is the point?!

The "stick" is the most absurd part of all, and I have already alluded to it. You cannot punish doctors and hospitals just because their mortality rates and readmission rates are higher that average. This will discourage treatment of the sickest members of the communities. Often times the only thing that doctors, nurses and hospitals have to offer a patient are palliative measures. We have to relieve suffering if we cannot do anything else.

The figures that the RAC demonstration project turned out shoul be examined closely by doctors and nurses in private practice and not just by a few 2nd tier people in teaching institutions who wouldn't know which end of a thermometer to put in a patient's mouth. Don't trust the bureaucrats who hire mercenaries to audit the people on the front line of medical care. They will surely yell FRAUD even when there is not any, and it will be for their own personal gain.

I'm a nurse Case Manager for a rural hospital in Arizona. RAC audits have already come to our facility. The auditors are allowed to look back to 10/07 for incorrect billing in chart audits. Any mistakes they find are mostly overpayments to hospitals. Very few are underpayments. RAC auditors are paid a percentage of what they find. Needless to say, they have alot of incentive. Potentially, this recouping of money, could lead to some hospitals collapsing.

K Normandin RN you are soo right. finally someone who knows how it really is.

I completely agree, in Kansas they owe millions of dollars to healthcare providers and many home health care agencies have shut down in the last 6 months...

Well, now you have some of my arguments against the bureaucratic movement against medicine. Does it surprise you that they find very few underpayments? If I were not paid to find them I would not look for them either. The problem is the auditors for the RAC. They are like all the other CMS auditors, most likely. You are guilty until proven innocent. The burden of proof is on you, not them. They never see both sides of a coin. I have never had one who listened and compromised. I have taken them to court repeatedly, at least 8 times, if not more. I have actually had an ALJ tell them to get off my back and let me practice medicine.

CMS has wasted weeks of my time that I could have spent in patient care or with my family, not to mention the frustration and resentment I have because of they do not recognize due process of law or equal protection under the law.

A person has to fight for what he believes in. Our government, both Democrats and Republicans seem to have forgotten the Bill of Rights, which they swear to protect and defend.

Wait until you hear from a Federal DA who threatens your facility with $10,000.00 for each of those mistakes and accuses you of fraud.

Any third party, government or insurance companies, paying medical claims for a patient have to develop rules that exclude care in some cases. Otherwise, patients in America will always an MRI or other high tech diagnostic procedure or treatment that is unlikely to help their health -- and doctors will provide in many cases (perhaps because they disagree with mainstream medical conventions or perhaps because it shuts the patient up).

If the third party is government, you need to combat this with well organized political pressure to make the disease "popular" and/or organized lobbying.

If the third party is an insurer, you need to appeal and perhaps sue them to combat this.

Outcome based healthcare is here to stay - as it has to be with third party payer systems.

I think it is really sad that a woman sick enough to be hospitalized and willing to spend her own SS money to make phone calls is just disregarded by everyone. Until people (Medicare and insurance companies) actually LISTEN to the ones who are pointing out the fraud, how is anything ever going to change? There should be an 800 number that anyone can call and report such abuse, and the people responsible for dealing with it should be required to get back to the whistle blowers and let them know the outcome. How about Medicare starting a website where people can report the details of known overcharges / fraud / abuse. It just should not be that easy for so much fraud to go on and on, at the expense of honest hard-working tax payers.

If the medication was administered by the hospital, the cost is always outrageous - that seems to be standard practice (somewhat justified as it costs the hospital something to provide this service). If the hospital has agreements with the insurers and SS to charge this much for administering this medication, there's no fraud, just (possibly) poor contract negotiations or bad government/corporate policies.

Some years ago (I don't know if it's still true), Medicare knowingly "overpaid" for chemotherapy drugs. It was known by doctors, Congress, and Medicare itself -- but also everyone knew that the Medicare reimbursement rates for other services associated with chemo were inadequate so this provided a way for doctors to stay afloat on Medicare payments.

Abby: The hospital may have billed Medicare $900 for your friends medication, but by being contracted with Medicare, Medicare would have only paid the hospital the contracted amount. Because hospitals must charge the same price whether you have insurance or not, the sad part is, people with no insurance would have to pay the full $900.

I couldn't agree more. I look at our country as a condemned house that you have inherited. You have to put money into it to make it livable again. All of this is going to take time. Too many people gave Bush another four years in office because they knew what ever it was he was going to get done can't be done in one term The bad thing about that was he only made everything worse by getting elected a second term. We need to give Obama time to straighten out this huge mess.

There has not been anyone running for an office of any kind that has not made campaigne promises.

Same sad story - Democrats were in charge the last 2 years of Bush's second term - the mess is largely democrat created.

The president's heart and mind is in the right place, I remember when former President Bush took office, he was on vacation for the first year of it or close to. Also Paul F., have you ever tried stopping a boulder rolling down a hill, it does not come to a complete stop when you put your hands out, it does take some time to slow it down. For all those stating that President Obama has a democratic congress he should have done more, if he did use that power without the full buy in of the American people as he is currently trying to do, you would have a problem, you would use names such as dictator to describe him. He has gotten a lot done, he is moving the country in the right direction, he is being a government for the people by the people, let him do his job. I remember hearing, “if you are not part of the solution, you are part of the problem” Figure it out people.

There has not been any evidence of substantial voter fraud in this country for generations. It's important to be factual when you debate.

S. Williams-430936

In October 2006, St. Louis election officials discovered at least 1,492 “potentially fraudulent” voter registration cards. They were all turned in by ACORN volunteers.

In November 2006, 20,000 to 35,000 questionable voter registration forms were turned in by ACORN officials in Missouri. Most all of these were from St. Louis and Kansas City areas, where ACORN purportedly sought to help empower the “disenfranchised” minorities living there. But the ACORN workers weren’t just told to register new voters. The workers admitted on camera that they were coached to tell registrants to vote for Democrat Claire McCaskill.

In 2007, in Kansas City, Missouri, four ACORN employees were indicted for fraud. In April of this year eight ACORN employees in St. Louis city and county pleaded guilty to federal election fraud for submitting bogus voter registrations.

And, that was just Missouri.

That’s not all. So far this year at least 14 states have started investigations against ACORN. Talk about a culture of corruption. It is so bad that Representatives of Congress have asked for the Justice Department to investigate, and GOP presidential candidate John McCain is bringing it up in his stump speeches. The Obama camp is stealthily altering its “Fight the Smears” website to distance themselves from the organization — quite a challenge considering how close their candidate’s association has been with the group.

The liberal vs. conservative, voter fraud vs. voter intimidation debate will no doubt continue after this election. But this year, with the assistance of scandal-plagued ACORN, it appears that — so far — the voter fraud side is winning.

For further reading enjoyment see http://pajamasmedia.com/blog/the-complete-guide-to-acorn-voter-fraud/

And we will forget about the fraudilent campain contributions from FOREIGN COUNTRIES.. Than have been PROSICUTED and CONVICTED.....