a lot of conservatives have been saying that for a long time , not "get rid of medicare" but clean up the fraud and waste and quantify that it has been done AND THEN if we need to talk about more money it is at least a credible conversation

Last I heard the Conservatives say is"OH, NO, we can't have consumer protection, that is too much Government control. We got to let the 1% steal more money, to make up for the little they pay in taxes.

I'm sure there's a powerful lobby behind these companies, just like there is behind big pharma. As far as the Republicans cleaning up Medicare--some joke. It's my understanding that Bachmann's husband, for instance, gets a good part of his income from Medicare payments. Dig deeper and follow the money, and the scams and schemes they'll uncover will easily pay for the money spent on additional oversight.

"Dig deeper and follow the money, and the scams and schemes they'll uncover will easily pay for the money spent on additional oversight."

It is not just Medicare.....IT IS ANY GOVERNMENT RUN ORGANIZATION..... AND, our so called "elite" politicans will do NOTHING ABOUT THE FRAUD, WASTE, and ABUSE.

Yep, the VA is one of them.

Susi

he does medicare covered work...are you saing that he should not collect LEGAL medicare reimbursments?...in your libby "take from the haves" sort of way?...or do you think that doctors should just do medicare work for free?...in Husseins class warfare way...interesting...your piont seems rather shallow and off target

"big pharma"..."big oil"..."big business"...hahaha...typical liberal pablum , diatribe and parrot talk....what about libby "big welfare"..."big food stamps"..."big section 8 housing"..."big anything free at taxpayers expense"..."big healthcare scam" ?...isn't it cool?

As a physical therapist, I would say that your comment is right on the mark. This is what happens when health care is run like any other business. How is it that a facility must have 33 hospice admissions per week? Human illness doesn't work that way, but this is typical in the health care industry. Quotas for admissions, for production, for procedures - the list goes on. It is no longer an industry with the best care of the patient in mind, it is instead concerned with the most profit regardless of quality of care. Golden operates nursing homes, as well as Hospice care and home health. I'm sure patients are shuffled around these various agencies in order to milk as much Medicare money as possible.

Best part of this is, Golden used to be called Beverly Health Care. They had the worst reputation in the nursing home industry, so you just change the name to shed the reputation. Big business health care!

Yes absolutely right. Health care is big business and it is now run as one. When I started in the field, it was all about what was best for the patient, now the mantra is: No positive bottom line, no hospital. That justifies everything...

A few years ago most of the hospitals in Washington state were in the red; this allowed business administrators to take over and now they hold almost all of the power in the hospital. Doctors now work for the hospital and are paid by them, since they can make more money due to lowering reimbursements and increased expenses. Thus, doctors are beholden basically to the hospital administrators and get booted if they don't document to maximize reimbursement.

I'm not sure this is actually a bad thing, since docotors do tend to document poorly vis a vis the medicare rules are so archane that hospitals need care managers (yet another BIG expense) to feed the doctors the rules, so they can document correctly, etc. This allows hospitals to survive. Talk about too big and important to fail, (as hospitals actually do something physical rather than just shuffle virtual money around)! So, while I don't like hard core administrators running hospitals, I don't see an alternative, given the environment.

we DO believe in the fraud...that is why we need to cut off all increases in funding until the stupidity is cleaned up and monitored

J100...sorr , your plea for "universal healthcare", ax payer paid , is not the answer

As a claims specialist, I did billing for Medicare, Medicaid and private insurance. It is no surprise to me that fraud is rampant. There is no oversight and providers seem to feel they can bill whatever they want for services. As my boss said, "They don't know what it costs; it costs what we tell them it costs." I grew tired of arguing and quit. I, for one, want no part of fraud. She's now out of business, thank God!

Harry:

Where in my response do you see any call for universal health care?

Contact your local Active Aging, or your state's Department of Health. Either one should be able to help.

I don't understand this. I know several people in Ohio who have had Hospice IN THEIR HOMES for their last few weeks of life. That is their main priority: to give the patient pain free care in comfortable suroundings. Your case must have been different, or was misunderstood.

It's the same here in TN.

dasdbobb--so sorry about your experience. You may also try the AARP website to see if they recommend a resource, and then there is 2-1-1 (in other words, call 211) and see if they can tell you where to go for help in pursuing this.

I am a hospice nurse. When your wife was discharged from hospice you (or your wife) would have needed to sign a form called "ADVANCED BENEFICIARY NOTICE" or MEDICARE NON-COVERAGE FORM.

This is a Medicare form that explains the reason for discharge of her hospice services and why they were no longer covered. Also, this form gives you the directions to file an appeal with Medicare.

My guess is that you/your wife were not given this form. Call that hospice ASAP and ask for a copy of the form.

Hospice businesses are in it to make money. Period. They bill for everything imaginable, then the goal is NOT to spend it on you. If they fear your care may actually cost any where near what they receive, well you are not profitable and will not be enrolled or kicked out.

What I find especially galling is the way they pull at heart strings to get folks to volunteer and donate. Every free man hour or donation is profit that goes home in some big wigs pocket.

What started out as a humanitarian effort to deal with end of life issues has been twisted into businesses profiting from death.

When my mom died, Hospice nurses came in and did a great job with bringing peace and calmness. For that I applaud their performance.

As for fraudulent billing of Medicare/Medicaid, I cannot comment from a personal standpoint but I did see something recently where they finally caught a guy that would create a fake company, issue fake billing and then close the business before it became obvious what was happening. Funny that many of these fake businesses use UPS store addresses as their company address.

I'll gladly allow the government to allocate funds for rooting out fraud and abuse first and then root out inefficiency as long as it is fully transparent and the data is made public in an easily accessible website.

Blue Cross's parent company, Health Care Service Corp netted a $1-Billion profit for 2011.

Who's ripping WHO off??

There's a law that just went into effect this past December that limits how much insurance companies can earn. Large insurance companies MUST spend 85% of their income on healthcare costs (15% on overhead) and Small companies MUST spend 80% on costs.

BBJ714, These BC/BCs are owned by their customers and are non-for-profits. In this case, they pay out $165 million per day in claims. That is about $60 billion per year. Also, they have to maintain reserves for unusually large claims or for unusually large numbers of claims. That is what an insurance company does. Also, nobody forces anyone to buy BC/BS. If it were a for-profit, a surplus of $1 billion on $60 billion of claims plus administrative expenses would put them with commercial health insurers, not even the sixtieth most profitable industrial group by SIC code in the universe of businesses. You might crab about administrative expenses but the government (i.e., Medicare and Medicaid) has administrative expenses also and way, way higher fraud costs. I am on Medicare and it sucks. I would jump at the chance to be a BC/BS customer again.

@Rob Corelli, Blue Cross/Blue Shield is NOT a 'not for profit' in all states. in many states, it is a publicly traded company that has to bring in profits in order to keep it's share-value up. my mom worked for them for more than a decade, and she became very sad and burned out over the way she was forced to fight to get her customers the benefits that they had paid for. ironically, she died due to the negligence of her HMO doctor. Mom was a Blue Cross employee but even she couldn't afford their insurance! when she passed, I inherited her stock shares that had been given to her as part of her benefits package.

@ BBJ714, The insurance companies have to ripoff their customers to cover the doctors and the health care facilities that are ripping them off. I'm sure you have heard the phrase "$h!t flows down hill" Well guess who is at the bottom of the hill. The people who are buying the health insurance... Now guess who is at the top of the hill, The doctors and the health care facilities... The insurance companies are the middle men...

When you boil it down to how insurance companies (any & all of them) work.. They are just HUGE PONZI schemes that our Govt. lets them call it a business. Think about it, you pay the insurance companies, (any of them, health, life, auto, home) your payments and everyone elses' all goes into a huge pot (there are a few exceptions like annuities). When someone makes a claim, that claim gets paid out of that huge pot of money that everyone has paid into. You help to pay other peoples insurance claims, and vice versa when you make an insurance claim. The doctors and the health care facilities know there is a huge pot of money sitting there, waiting, ready to be claimed, all they have to do is submit the paperwork, maybe add a few extra tests, or send a specialist in to see the patient, "hello Mrs. Jones, how are you feeling today. Oh i dont feel so well today Dr Ahmadinajhad, my back is sore today" spend 3-4 minutes with the patient then leave, BAM theres another consultation fee added onto the claim. And since Dr Ahmadinajhad is a specialist, that consultation fee is another $325.00. The specialist tells the nurse to give Mrs. Jones 500mg of acetaminophen, (Tylenol to us) which costs $7.00 per capsule when it comes from the facility pharmacy. But you can buy the generic brand at any grocery store for $5.99 for a 50 capsule bottle.

So BBJ714, When you look at the whole picture, they are ALL CROOKS, ripping everyone off!!!! Its just that we are at the bottom of the food chain in the insurance industry.

Yes it is..........I know from personal experience......my mom, my aunt and uncle, a real close friend and people from church.

Sounds to me like you had unreasonable expectations of your husbands illness. Hospice is intended to serve the needs of a patient with a life-limiting illness. If you or your husband were not on board or did not understand his prognosis, you would not have a positive experience with hospice. In my experience as a RN in hospice, it is the fault of the doctors and family members when a patient is not able to have a positive hospice experience. This usually occurs because a loss of control and anger at the situation. Not because hospice didn't do their jobs.

VERY well said Out of Luck! I have 18 years experience working hospice and you are absolutely correct. Hospice is not for all dying patients and all families. We do a great job for those who want us.

You are mixed up, if business commits fraud its "just doing business" if citizens do it they are criminals!

@ nad rennat, There is truth to your theory... But i don't think its limited to the GOP only. The money will and does go to who ever they want to motivate, irregardless of party affiliation..

You're mistaken. Hospice is paid a per-diem (a daily rate which varies state to state). In NJ, for example, the daily rate paid by Medicare for routine hospice services is approximately $160/day. This is for EVERYTHING! This money covers the following: RN, LPN, HHA, Social Workers, Chaplains, Bereavment for 13 months post-death, medications realated to the terminal illness and equipment such as a hospital bed or diapers.

This is a bargain.

The average nursing home stay in NJ is approximately $350/day routine care. AND the patient and family still need to provide payment for medication, supplies and rental of equipment.

You are correct in saying that a persons life expectancy should be under 6 months to qualify for hospice services (if their disease runs its normal course). There are guidelines we use in hospice to help use determine who is eligible under Medicare and the Conditions of Participation and Local Coverage Definitions.

If she came off off hospice, chances are she was not eligible to begin with. Coming off of hospice services should be an exception, rather than a rule.

My Mom was enrolled and then refused because Non Hodgkin Lymphoma destroyed her kidneys. She would last maybe as much as a month or 2 with dialysis but only a few days if she did not have it.

That month was not quick enough for Hospice. The only way they would take her as a patient was if she refused dialysis. Choose to immediately start becoming sick and dying and dead in hours instead of trying to enjoy what few days you have left? Thats assisted suicide, not Hospice.

She was kicked out of the program because the dialysis costs would not create a profit for them. At that point they would do NOTHING but hand us some brochures. We even asked if we could pay out of pocket for the specific care that we needed, that was nearly laughed at. We did what we could for her at home for as long as we could, but I am sure her final days did not have to be so miserable. She died less than 3 weeks after Hospice refused her.

I believe the folks that provide the hands on care really care about helping patents through this final journey. But business has twisted this once honorable profession into a scheme to take money from desperate people and profit from thier deaths.

What's new is the abilities of our government to pursue Medicare fraud, it cuts wasteful federal spending

AseraCare & Golden Living suppose to be nonprofits

Where did you get the information that AseraCare and Golden Living are supposed to be non-profits? They do not claim to be non-profits on their websites or in their promotional materials? Sometimes we assume that businesses that operate nursing homes or hospice services ARE non-profit. That is not always the case. I would suggest all individuals do a little homework to see if the organization they are working with is a non-profit or a for-profit. I would always choose a non-profit over a for-profit any day (even though I am sure there are some non-profits that don't do business 100% on the up and up, my chances with a non-profit are still better).

No he was right, he was just half right that's all. If you can't keep your doors open without taxpayer bailouts then your company has become defunct and it's time to close the doors. Everything has a beginning and an end.

Our auto industry survived & is going strong... This could be the death of AseraCare

Nope, no businessman or economist will ever say killing an auto industry is a good idea, especially on the edge of a Great Depression & a very long delicate recovery

But, that was what Romney did as a businessman... Cause businesses to fail

I hope this is the end of AseraCare. Any company that has operated in the manor that it has and has stolen money from taxpayers by exploiting people, telling them they will die in a short amount of time, needs to close.

Actually it was Obama Care that was able to catch this on time for the Justice Dept to do something

Just one example of how the Affordable Health Care Act is working for American tax payers & our families

Dutch,,, Don't you think it's time to start giving credit to the GOP's Gingrich & Romney for their efforts in creating it? Come to think about it, even Santorum was all for it at one time.

The problem prior to Obama Care was there wasn't enough time for the government to file charges...

Now we can have enforcement, consistency of enforcement depends on funding from Congress when many say it's just more bureaucracy.... Some of it can be funded from recovery of fines

I am a RN who works in hospice. Your misconception is one I hear too often. The reason it seems that patients die on hospice with morphine is that someone waited too long to put her on hospice services to begin with. Morphine should, however, only be used for short-term pain or respiratory difficulties. It leaves the body rapidly and people build a tolerance that requires increased dosaging to achieve affect. Hospice is not the problem. It sounds to me like you had a bad nurse who didn't know what he/she were doing. Next time you find yourself needing a hospice company, look for a non-profit company with a RN who is CERTIFIED in Hospice and Palliative Care.

Again very well said. Sounds like a lot of people just need education.

You're ignorant.

David you are absolutely right! Greed empowers Golden Living. The facility administrators are given a year end bonus ,if they can keep costs down. If the administrator does not comply, then they are fired. The end result , is that the residents pay the price, by being neglected & abused due to shortage of supplies & under staffing. My mother payed the price with her life. The corporation operates on corruption. Complaints to the state health department are 'swept under the rug'. If anyone has a loved one in a nursing home etc, I highly recommend that you place a hidden camera in their room. That is the only way to prove what happens behind closed doors. And Golden Living should have their doors permanently closed!

That is the penalty.

wildlife, did you even bother to read the article? because it isn't about individuals defrauding Medicare- it is about several large corporations defrauding Medicare and getting caught.