Interesting article about healthcare

[BanginJimmy]

Straight from todays Wall Street Journal.

http://online.wsj.com/article/SB123966918025015509.html

Its not very long and I found it very interesting.

[Paul]

He is exactly right - one of the biggest factors w/ privatized health care is that their networks of doctors can be dropped at anytime and the claims our thoroughly checked through administration services.

I used to work for a TPA and they administer all health claims for private companies. We even did some gov work as well for some major school systems.

Gov plan isn't necessarily a bad idea but the means at which it operates can determine its true value.

[BanginJimmy]

These 3 statements really set the tone for me and I think we can agree that the WSJ is about as unbiased as we can get on a subject.

In fact, the total amount of Medicare fraud is unknown. The government does not measure or estimate fraud in its programs; instead, it measures payments made "in error." According to Medicare's own most recent data, payments made in error amount to over $10 billion annually. (Medicaid's payment errors in 2007 equaled a whopping $32.7 billion, according to a report by the Department of Health and Human Services.)

Wow, AT LEAST 42.7B a year in fraud that we pay for when we pay medicare taxes (I believe they come out of the same pot, but I could be wrong).

Gets better though.

Medicare spends less than one-fifth of 1% on antifraud measures

.2% of funds are dedicated to fighting a problem that hemorrhages more than 42B a year?

And finally my favorite part.

Worse, in four of the past five years Congress has turned back Medicare's pleas for $579 million of additional antifraud funding, on the grounds that these dollars subtract from the budget funds for curing cancer and anti-obesity campaigns. Based on experience, Congress will always underinvest in fraud. Yet according to a House of Representatives Budget Committee hearing in July 2007, return on investment for certain Medicare antifraud measures were estimated to be in excess of 13-1

I know I would put the life savings into ANY investment that had a guaranteed 13-1 return. I wonder why the govt doesnt do the same with a mere 600M.

[Paul]

I know I would put the life savings into ANY investment that had a guaranteed 13-1 return. I wonder why the govt doesnt do the same with a mere 600M.

its b/c the gov can be worse than the problems they try to fix

i would say the fraud on medicare is much higher than gov even knows about.

[eraser4g63]

1.Wow, AT LEAST 42.7B a year in fraud that we pay for when we pay medicare taxes (I believe they come out of the same pot, but I could be wrong).

2..2% of funds are dedicated to fighting a problem that hemorrhages more than 42B a year?

1. They do come out of the same pot, and actually that tax you pay into medicaid is also leeched out of there as well. Which is abused more and needs to be shut down all together or regulated a lot more than it is.

2. The issue is that yeah they only spend 2% but they also medicare does not pay out, they typical medicare payment is actually pennies on the dollar for hospitals and EMS. Under the payment schedules Medicare is reducing the amount paid out. There are actually cases of medicare fraud, but alot of what they are classifying as fraud is the EMS companies and Hospitals having to bill a grey area to get paid.

3. Say you call 911 and I come to your house and pick you up and there is something very wrong with you, ( for ease of explanation I will not go into details) The fact that you called 911 moves the call into a billing category of BLS1 Emergency(pays $100 for initial call out), Now say I hook you up to my cardiac monitor, give you oxygen and start and IV now it is an ALS Level 1 ( now pays $250) Now I have to give you at least 3 drugs or perform two additional, what they classify as, ALS interventions to move it into an ALS Level 2 (pays $350-$450) Then we charge an additional $7 a mile. Now back to you calling 911. I ( the paramedic) have to ride in the back to the hospital so cause you are really messed up I put you on a cardiac monitor, give you oxygen and start and IV additionally i have to give you Nitro, aspirin and i run a 12 lead EKG cause i think you are having a heart attack. Now we are at an ALS Level 2, and you live 5 miles from the hospital. Your total bill would probably be around $475-$700 because some services can itemize the supplies used ( Grady will charge you for sheets or a blanket i kid you not). So we send you a bill for $475 or we bill you insurance company and its over cause you payed or they paid. No change it around and we send it to Medicare they pay $100 and then we usually have to write off the rest. If we send it to medicaid they pay us $65, but if you bill medicaid and they pay any amount from $1 to the alloted $65 they have a clause that states you cannot bill any one else including the person transported. I know what you are thinking hey $475 thats not bad for 30 mins to an hour long call/transport. But in all reality what about if thats the only call we run that day? Then thats $475 for a crew of two and the ambulance, insurance ( which is by no means cheap) equipment, drugs the list goes on. so What we do is bill the grey area medicare has, its not wrong by any means its just the only way we can collect. That is what they Gov't is classifying as Fraud. We actually have a class during paramedic school that teaches us how to properly write PCRs ( Patient Care Reports) so that medicare/medicaid will pay because if you use the wrong verbage of don't document every little thing then they wont pay.

*Disclaimer-The actual base call out and milage cost will vary*

[BanginJimmy]

2. The issue is that yeah they only spend 2% but they also medicare does not pay out, they typical medicare payment is actually pennies on the dollar for hospitals and EMS. Under the payment schedules Medicare is reducing the amount paid out. There are actually cases of medicare fraud, but alot of what they are classifying as fraud is the EMS companies and Hospitals having to bill a grey area to get paid.

The actual amount spent is .2%, not 2%. The cases I found that totaled over 30B resulted in criminal and or civil penalties, not just questionable billing.

The article also explained how much of medicare's price fixing has caused care givers to pass that expense onto others.

[eraser4g63]

Sorry I miss read, basically we have no choice but to pass the bill to others because you cant operate in the red or you end up like Grady or like many other EMS companies bankrupt.