Huge Medicare Bust

Several arrests  from five different states on Medicare Fraud occurred recently.  States involved in this fraud including:  New York, Michigan, Louisiana, Texas, and Florida.

More than 30 people were arrested in conjunction with this recent . Among the suspected were nurses, doctors, and others.

The total amount that has been allegedly scams sits currently at $251 million.

Some of the breakdown of the scams include:

1.) Unnecessary equipment
2.) False patients
3.) Physical Therapy that was never received
4.) HIV treatment that were never received

One such incident in New York found that a fraud was discovered that brought in $70 million dollars alone for physical therapy. The clinic apparently would pay off patients for their Medicare numbers and would provide bonuses for each additional patients. Undercover agents were sent in and they were paid off as well, as part of the sting operation.

Medicare and Medicaid are a serious industries and a potentially lucrative areas for scams and frauds. Recent health care changes by Obama and overalls to the health care industry may be afforded as the government begins cracking down on fraud that may be costing this country over 60 billion dollars a year.

Health Care Spending is an interesting and concerning area our national budget. Many changes may need to be put into place.

Fraud of the medicare systems is happening all the time and from very small scams to quite extensive and elaborate plans.

Federal authorities have been cracking down on many frauds over the past few years. In this most recent raid, over 360 agents were used across the five states. Federal officials have promised more time, money, resources, and manpower to fight fraud. In addition, they have set up strike forces in several cities. It is believed that Miami is the central base for many fraudulent scams over the past few years. This most recent raid found that almost $150 million dollars was from various scams and frauds in that city.

One must ask, is fraud worsening?

The answer is an alarming yes. Criminals are finding easier ways to attempt fraudulent activity. Medicare Scams are often an easy, yet profitable way to bring in large amount of money. One woman’s medicare number had over 3,500 claims on it.

What can you do to keep safe?

1.) Understand the Medicare program

2.) Be familiar with your number

3.) Keep your Medicare number safe

4.) Call your Medicare claim service to see if your number is being falsely used.

Medicare is not the only affected medical area. Medicaid has also been affected. Take a look at the following blog article about Medicaid in Utah

Health Care Spending

Health care is an area of demanding and controversial health care programs, insurance and spending.  

Medicaid and Medicare are government run programs that account for a large portion of health care cost.

Insurance overall is a funny business – there is insurance for almost anything including pets, fire, medical, vehicle, and others. Insurance has become so essential that many either overspend for insurance or work in terrible jobs, just to get insurance.

But then there is the large portion of individuals, for whatever reason, are unable to get insurance at all.

Private insurance is even more difficult to understand. These programs are allowed by employers or private individuals and vary from company to company and policy to policy. It is believed that over the last 7-10 years, employee-sponsored health insurance premiums have increase over 100%. This is almost 5 times the amount of inflation over the same period of time.

This is markedly more difficult for individuals and employers. Less and less companies are able to afford these important programs. And this will continue to get worse and worse.

It is believed that by 2020 or so – it will cost a family of 4 more than $25,000 per year to cover health insurance. Currently it is almost $13,000 per year for health care.

Cost for employers will continue to rise as well. Currently the cost to employers for insurance is just over $300 billion dollars. Within 10 years that number may jump to the mid $800 billion dollar range.

Don’t be fooled either – the coverage will not improve as time continues. Increasing costs, number of sick, and rising average age will continue to worsen the actual coverage by each individual.

Increasing Health Concerns

1.) Health Care Spending

– United States is leading all countries in the percent of GDP that is spent on Health Care.

– United States currently spends 16.2% as of 2007 and was around 15% in 2006

– Switzerland and France follow at around 11%

– Other countries above 10% are: Canada, Belgium, Germany, Portugal and Austria

– most of these values are from 2006

2.) Cost

– as the cost per person rises – the burden increases for employers and individuals to get enough coverage and the correct coverage

– $2.2 trillion dollars were spent in the United States in 2007 on health care costs

– $700 billion in 1990

– $250 billion in 1980

3.) Bankruptcy and Foreclosures

– Over 50% of bankruptcy are linked to lingering health or medical expenses

– 1.3 plus million people loose their homes because they also have medical expenses that can’t be meet

– Many families with the above mentioned health care costs do have insurance – over 75% on average

4.) Aging

– It is believed in the United States that by 2030 the number of individuals over the age 65 will double

– Over 70 million Americans will be over 65 at that point

– This will comprise around 20% of the population

– The cost of an older individual is 5 times greater for someone over 65 than under 65 [on average]

– The overall projected spending is believed to increase by 25%

“The aging of the U.S. population is one of the major public health challenges we face in the 21st century. One of CDC’s highest priorities as the nation’s protection agency is to increase the number of older adults who liver longer, high-quality, productive, and independent lives.” Julie Louise Gerberding, Md, Director, Centers for Disease Control and Prevention – 2007

5.) Smoking, Poor diet, and physical inactivity

– It is believed that these 3 items result in 35-35% of deaths each year

– These are preventable conditions

– Are quite costly to individuals, companies, governments, and tax payers

– Are risk factors for serious medical conditions of: Diabetes, Stroke, Cancers, and Heart Disease among others

6.) The Uninsured

– Some do not qualify for government-provided health insurance

– Some do not qualify for private health insurance

– Not provided insurance by employer

– Some are unable to afford health insurance

– Some choose not to have health insurance

– As of 2007 – 15% of population or 45 million individuals were without health insurance

– 2008 numbers are expected to be statistically similar to 2007 despite the recession, but a rise to 46 million is anticipated

According to the US Census Bureau, in 2007:

Of the 45 million uninsured:

. 37 million between ages 18 and 65
. 27 million worked at least part time
. 38% had household income of greater than $50,000
. 36 million are legal U.S. Citizens
. 10 million are non-citizens (This may or may not include illegal immigrants)
. 20% could afford insurance
. 25% are eligible for public coverage
. 55% need financial assistance to cover health insurance

7.) Fraud

– It occurs daily and helps “almost” no one

– Occurs on many levels and by many individuals

– Health Care is often about profit

– The most visible areas are Medicaid and Medicaid

– However, fraud occurs in all health care areas

– It is believed to occur on 5-10% of all health care expenditures

– Your increased health cost is, at least in part, to health care fraud

8.) Disparities

Defined by the Health Resources and Services Administration as …”population-specific differences in the presence of disease, health outcomes, or access to health care.”

Goldberg, J., Hayes, W., and Huntly, J. “Understanding Health Disparities.” Health Policy Institute of Ohio (Nov 2004) page 3

– Medicare and Medicaid spending is often quite different from state to state

– Sometimes the spending amount is double in one state when compared to another
. Example [Medicare in Miami in 2006 – $16,351 and in San Francisco $8,331]

– Access to health care and insurance is often a cause point, but not always

– The cost for such disparities may directly impact social and economic status

– Race, ethnicity, socioeconomic, sex, age, medical conditions, sexual orientation, and more are all linked to disparity

All is not loss

We are doing several things well – probably not perfectly but well

1.) Improved overall medical quality and treatment allow for a larger number of patients to live longer

2.) Improved Mammogram screening

3.) Improved Cholesterol screening

4.) Overall awareness for preventative care increasing, it still must increase in importance to not only improve care, quality of life, and overall balance health care costs.

5.) Disparities have begun to be looked at more closely and continue monitoring and goal setting to manage specifically targeted areas have been put in place.

Post originally seen at InterActive Health: Health Care Spending

For further information take a look at the following

– http://www.nchc.org/facts/cost.shtml

– http://www.cdc.gov/aging/pdf/saha_exec_summary_2007.pdf

– http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5813a5.htm

– Goldberg, J., Hayes, W., and Huntly, J. “Understanding Health Disparities.” Health Policy Institute of Ohio (Nov 2004) page 3

– Centers for Disease Control and Prevention and The Merck Company Foundation. The State of Aging and Health in America 2007. Whitehouse Station, NJ: The Merck Company Foundation; 2007.