Both the New York Times and Washington Post reported today on a $2 billion Medicare scam. The way it worked was simple:
- Scammers buy a few small medical supply companies (seven, to be exact).
- The companies send Medicare bills for millions of phony catheters.
That's it! But how did they get away with it? The Post explains:
Urinary catheters made an appealing target for potential scammers because orders for the low-cost products — small tubes often made with latex or silicone — could escape some of the scrutiny that accompanies billing for expensive equipment, surgeries and other high-cost claims, fraud experts said.
Huh. The Times provides this chart of catheter billing:
I'm a big proponent of being patient until all the facts are in, but this truly looks insane. Catheters were billed at a steady $50 million per quarter, and then, in one quarter, it jumped to $600 million. And Medicare has no systems in place to flag that? My credit card company flags my account if I spend a thousand dollars in a different time zone.
But apparently nothing like this was in place. The scam wasn't even uncovered by Medicare, despite skyrocketing billing and lots of complaints (the scammers submitted bills using real customer and doctor names). It was uncovered by a private organization.
A catheter bills out at eight dollars?
Damn, I'm in the wrong business.
Obama started to upgrade the computer systems in the government...and they still have a long way to go.
"...Catheters were billed at a steady $50 million per quarter, and then, in one quarter, it jumped to $600 million. And Medicare has no systems in place to flag that? ..."
But waste, fraud and abuse of government money is a myth?
No, but in order to fight fraud you need to hire fraud investigators. To fight Medicare fraud hire Medicare fraud investigators. To fight Tax fraud, hire IRS investigators. To fight fraudulent gun sales and purchases, hire AFT agents. To fight immigration and hiring fraud, hire immigration investigators.
Which political party, with its leader based in Mar-A-Lago, does not want to do those things?
To collect taxes that rich people evade, one must hire more IRS agents (who return many dollars in otherwise uncollected taxes for every dollar they cost). But which political party etc.
The supporters of said political party either do not care at all about facts or merely get angry at the ones that inconvenience them. And there is a universe of politicians and media who cater to those preferences. And here we are.
I'm sorry, but I'm sure that Medicare already has at least *some* fraud investigators, and if they couldn't catch something like this, I really question Medicare's ability to locate and/or motivate competent fraud investigators, even with more funding.
Perhaps the existing investigators were working other cases? Only so many hours in the day.
No, clearly the investigators are BIG GUMMINT WASTE OF MAH TAX DOLLERS and therefore, like IRS auditors, they should be CUT SO MAH TAXES GO DOWN. And then all will be well. (Also wimmin should shuddup.)
Jesus, don't know how you got that - very much in favor of doing more investigations and audits. I don't think it's unreasonable to be concerned about the quality of the work being done with public money, though.
Medicare missed a $2 billion dollar fraud that is incredibly obvious when looking at a time series chart of their reimbursements. That's the kind of miss that should alarm us, and the agency should absolutely be asking itself/being asked how to avoid something similar in the future, regardless of whether they get more funding for investigations. It is very hard to imagine larger and more obvious frauds than that and it could indicate a problem with prioritization that should be addressed.
That is insane. Because in my experience in Medi-Cal (Medicaid in California) there is a limit on the number a catheters a patient can order quarterly. If you have X number of patients able to order Y number of catheters the number should not dramatically rise.
X x Y = Z
(Good god, have not used Algebra since HS. I guess it does come in handy ever 50 years or so.)
One might guess then that they fiddled X.
Hence the stealing and use of real doctor and patient information.
You've probably used it all the time and didn't think about it.
But this was inventing new patients to spread it across.
There's a pretty old book entitled "License to Steal" about medical billing fraud. As I recall the author says there was no real information on the extent of this fraud. He could only identify one real attempt to quantify the extent of fraud. It was made in Texas and the medical industrial complex pretty quickly got it squashed.
So people throw around numbers like 5% or 10% of the nation's healthcare expenditures go to fraud. But, no one really knows. It could just as easily be 15 or 20%.
The fraud comes in many forms. You get sent home with a wheelchair. In a week you aren't using it at all. Is it a rental or did your insurance buy it? It takes some effort to find out and this task is about a thousand down on your priority list. So when you kick the bucket, your heirs find six wheelchairs stashed in the attic.
Or you get billed for a surgery that never happened as my mother did. She got that squashed. But most people aren't even aware that this has happened.
Insurance companies have little incentive to worry about this stuff, especially if they are acting as administrators for a large company's health insurance program. The higher the bills, the bigger the administrator's fee.
> Medicare has no systems in place to flag that?
From the outside, failure to catch problems early seems inexplicable, be it insurance fraud, terrorist activity, computer security, or border control. Playing offence is sometimes much easier than playing defence. Like in many other areas, AI will likely raise the level of play on both sides.
Frankly, I’m less surprised that clever, motivated people found a new way to cheat, but that they were so damn greedy. Once I manage to scam the jabberwocking comment section for $1M you’ll never hear from me again.