Medicare being hit by fraud

The Law Office of Jeffrey L. Weinstein

Medicare is in danger. Each year, roughly 10 cents of every dollar budgeted for Medicare program is stolen or misdirected before it helps anybody. Looked at another way, about $1,000 is lost per Medicare member through theft or waste each year. That is according to the federal government. But it could be far worse. Harvard University professor, Malcolm Sparrow, a leading expert on health care fraud, says the true amount lost to fraud, abuse or improper payments could be 20 percent, or even as high as 30 percent.

Sparrow said, “The fact of the matter is, we don’t know how much is lost, We ought to know. We shouldn’t have to guess. But the truth would be hard to swallow.

It’s not just taxpayers who pay. Medicare beneficiaries also foot the bill in the form of higher deductibles and co-payments and cuts to services and care. Simply, fraud is directly harming the health of older Americans and compromising the program.

“The real damage is the winding down and gutting of services,” Sparrow says. “And it’s been happening for a long time.” Quite often the fraudsters:

  • Charge for services never delivered
  • Falsify records
  • Inflate claims
  • Steal your ID
  • File duplicate claims
  • Provide unneeded equipment
  • Buy off doctors/patients

Every recent president has acknowledged the problem, but the crooks continue to target the program, and new schemes spread across the country faster than officials can keep up. Why does Medicare continue to be a choice target for fraud? Critics say the problem is built into the system. Private health care programs investigate suspicious claims before paying them, but Medicare pays claims first and investigates later. Among insiders, that’s referred to as “pay and chase.” That’s changing, but progress is at a turtle’s pace.

The senior advocacy organization, AARP contacted the administrator of the Centers for Medicare and Medicaid Services, but did not get a response to any questions.

Kirk Ogrosky, a former federal prosecutor who fought Medicare fraud, says the bilking of Medicare should concern everyone, even those who are not yet old enough to take advantage of the program, because they pay for it through their taxes.

Ogrosky said, “Every American should be angry about it. If there is massive fraud, people should know that their benefits are going to be hit.” He Ogrosky believes the solution is more funding to stop fraud before it happens, instead of sending in federal agents later.

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