More Medicare Fraud

Following up on my last post, I wanted to share this recent CBS 60 Minutes article and video on Medicare fraud in south Florida.  It’s a tremendous example of how easy it is to steal money from the government.  Private insurance companies with a profit motive have more incentive to stop this type of fraud.  Unfortunately, the government has not had the motivation to seriously address this problem.  Dennis Jay at the Coalition Against Insurance Fraud has a great post on this topic here and a follow up post on how Democrats are getting more aggressive on fraud.

One of the commenters to Dennis’ follow up post makes a great point about private carriers who write Auto, Liability, or Workers’ Compensation insurance.  These insurers (full disclosure:  I work for one of them) pay medical claims every day and are subject to the same scams.  But they don’t have access to the same resources and, while there have been improvements in information sharing among these carriers, information sharing is lacking between them, the private healthcare payers, and government medical programs.  Groups like the National Insurance Crime Bureau (NICB) are targeting this issue and I forsee this being an area of focus in the coming months for insurance investigators.

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2 Responses to More Medicare Fraud

  1. Interesting article James. For what it’s worth, in Australia there is a long-running medicare system (since 1970-something), I’ve seen the efforts they are using internally to combat provider and recipient fraud in recent years. They come at the problem using every data source legally available to them. In many ways, this out-guns the insurance industry here who are hindered (even more than in the US) by legislation preventing data-sharing to combat fraud. This is not to say that Govt medical insurance fraud does not exist here, but it’s often caught and prosecuted. I’d say blatant medicare fraud is rare here. Also of interest: many government departments in Australia now use the Private Investigation industry to supplement their internal Investigation Units. This has proved very successful and is expanding to other groups. Perhaps a similar model to supplement government services with industry expertise is what’s needed?

  2. James Ruotolo says:

    Thanks Stuart. Medicare fraud is a big challenge here in the states. With over 45 million beneficiaries between Medicare, Medicaid, and Children’s Health Services and a financial outlay of $600 Billion, the sheer size of the program is staggering. It’s no wonder that fraud and abuse run rampant. I like your ideas about augmenting government investigations with private investigators. In fact, Medicare outsources a large portion of the work is does in all aspects of claim administration. I think there just needs to be a stronger focus on anti-fraud measures and a lower tolerance for this type of abuse.

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