Insurance fraud is rampant
The world frequently disappoints us. We all hope people will prove honest and good neighbors. Yet we more often find ourselves on the receiving end of dishonesty and selfishness. When this is just one-to-one, we can attempt to arrange our affairs to minimize future losses or opportunities for conflict. But when the dishonesty is on an industrial scale, it ends up costing us all extra dollars, and there’s little or nothing we can do about it. Over the last two or three years, it’s been impossible to pick up a newspaper without seeing a story about rising auto insurance premiums, often caused by the rapidly increasing levels of fraud. That, as they say, is the tip of the iceberg. The wave of gangs crashing their cars and claiming medical expenses is only worth a few billion a year. Unfortunately, a few billion is peanuts. When it comes to Medicaid and Medicare, the FBI estimates the amount fraudulently claimed to be between $60 and 200 billion a year.
When you recover from the shock, you should ask why the range of the estimate is so wide. The answer is depressing. Although the FBI is on the case, it does not begin to have the resources to investigate the full extent of the problem. All it can do is to base the estimate on samples taken from different sets of files. Think of the top and bottom numbers as being the worst and best case scenarios. Your curiosity is piqued. How can the losses be so great? Does Medicare and Medicaid not have anti-fraud systems in place? Now comes the real killer. The administrations of both the entitlement programs have a “pay and chase” approach. This means they unquestioningly pay all claims and only if evidence later emerges of a possible fraud do they then chase for repayment. Needless to say, most fraudsters are rarely in a position to repay in full (or at all depending on how much time has passed). The result is massive fraud. It begins with health professionals billing for work they did not do and for treatment they did not deliver. Pharmacists invoice for drugs supplied even though there are no prescriptions written. And then, of course, come the actual criminals who set up fake clinics to bill insurers and the entitlement agencies. They last for a few months before disappearing.
To help fight the battle, some of the local FBI agencies are buying billboard ads begging us to act as whistleblowers and turn in the doctors we see billing the health insurance companies for tests and treatment we did not receive. Why should we care? Because when you add up all these false items on legitimate bills, these are billions paid out by insurance companies and the federal government. So those of us who pay health insurance premiums are paying way too much. Those of us who pay taxes are seeing billions of our tax dollars paid out to fraudsters instead of legitimate claimants who are ill. So the federal authorities should immediately withdraw the “pay and chase” policies. No suspicious claim should be paid. If this needs more staff, this creates jobs and is good for the economy. If it saves money, the jobs will be self-funding.
Under Obamacare, there’s a new accent on preventative care. The earlier the diagnosis, the more cost-effective the treatment. If access to reproductive care is also classified as preventative, this will have profound implications for the health insurance debate. This will open up a new war of words between the liberal establishment that favors funding women’s healthcare, and the GOP which campaigns aggressively to withdraw funding from any healthcare service that directly or indirectly supports abortion or fails to emphasize abstinence rather than contraception. So, because these health insurance issues should be resolved during 2012, we can expect men to begin debating how much healthcare women should receive.
