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Cracking Down on Medicare Medical Fraud

Money makes people do strange things. Unfortunately, that is true even for professionals who are able to make a healthy living without resorting to unscrupulous conduct. The striving to maximize profits, get more and more at all costs, is at the root of so much abuse, mistreatment, and crime. The perverse motivations can be found everywhere, from the legal world to the medical world. It is never acceptable, and it must be called out in order to have accountability and fairness.

In the medical arena, for example, the problem often manifests itself in the form of Medicare fraud. The reasons are simple. Medicare (and Medicaid) programs pay for a large percentage of medical care in the United States. When a doctor performs work, the payment for that work will often come from one of those programs. Functionally, this means that the doctor will send a bill to Medicare which will then make a payment to the doctor for those services, usually for a set amount that both sides know will be paid for the work. This system means that there is trust placed with the doctor to ensure that the billing is accurate and approprate. Sadly, some medical providers are tempted to breach rules with regard to that billing, ultimately trying to syphon off more money from the public coffers.

Challenging Medicare Fraud
This conduct leads to significant wasteful spending–money that all taxpayers are forced to bear. For this reason, President Obama has long-been on a mission to cut out as much Medicare fraud and waste as possible. With public budgets under extreme scrutiny, there is little room for funds to be spent in unnecessary ways. Efficiency and accountability must grow in importance to ensure we all getting the most bang for our buck.

A recent Crain’s Chicago Business article, for example, discussed the amped up efforts by federal officials to beat back abuse of the Medicare system by professionals. The article reminds that some schemes to defraud the system are downright ridiculous–not just slightly distorting the truth but flatly doing whatever neccessary to get more money. For example, some have submitted bills for working more than 24 hours in a single days. Others have claimed reimbursements for patients who were dead at the time that the service was supposedly provided. Still other cases invovle medical industry folks claiming federal funds for giving patients expensive services or equipment when in fact the equipment was second-rate and the services were of less quality.

The issue exists nationwide and has been particularly problematic in Chicago. For that reason, the city was one of a few given a grant to better police Medicare fraud. The policing effort is laborious and time-intensive, requiring detailed examination of billing records to determine if there are any irregularities which might indicate fraudulent or abusive practices.

Interstingly, the beefed up enforcement efforts from federal officials are paying clear dividends. In the past there were only a few criminal prosecutions in Illinois for these issues. Since 2011 there have been twenty. Nationwide officials estimate that about $11 billion has been recouped to the program since 2009. This represents a significant savings–money that can then be re-used to provide actual care to the senior residents who depend on the program instead of in the pockets of medical officials who insist on trying get as much money for themselves as possible regardless of the long-term consequences.

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