Medicare, Medicaid, Veterans Health At High Risk For Fraud, Waste, Abuse

InsFormSmallThe Government Accountability Office (GAO) has published its biennial update of federal programs “that it identifies as high risk due to their greater vulnerabilities to fraud, waste, abuse, and mismanagement…”

Healthcare programs feature high on the list. Medicare, the entitlement program for seniors, and Medicaid, the joint state federal welfare program for low-income households, are longstanding members of the list; and the GAO notes that legislation will be required to fix them: “We designated Medicare as a high-risk program in 1990 due to its size, complexity, and susceptibility to mismanagement and improper payments.” “We designated Medicaid as a high-risk program in 2003 due to its size, growth, diversity of programs, and concerns about the adequacy of fiscal oversight.”

So, that would be 27 years for Medicare and 14 years for Medicaid. Seen any progress?

This is the second time the Veterans Health Administration has made the list of high-risk programs: “Since designating Department of Veterans Affairs (VA) health care as a high-risk area in 2015, we continue to be concerned about VA’s ability to ensure its resources are being used cost-effectively and efficiently to improve veterans’ timely access to health care, and to ensure the quality and safety of that care.”

Although VA’s budget and the total number of medical appointments provided have substantially increased for at least a decade, there have been numerous reports in this same period of time—by us, VA’s Office of the Inspector General, and others—of VA facilities failing to provide timely health care. In some cases, the delays in care or VA’s failure to provide care at all reportedly have resulted in harm to veterans

As I noted in a recent Health Alert that was widely syndicated, this cannot be fixed by the federal government and the system should be privatized.

It should also be noted that “Ensuring the Security of Federal Information Systems and Cyber Critical Infrastructure and Protecting the Privacy of Personally Identifiable Information” has been designated high risk since 1997. Recent breaches of federal databases have brought this to the public’s attention.

Despite this failure to secure its own data, the federal government has had the temerity to try to impose a standard Electronic Health Record onto all the nation’s hospitals and doctors’ offices.

Comments (13)

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  1. Ron Greiner says:

    Medicaid is nothing but fraud and block granting to the local state politicians will encourage more fraud. Republican age-based tax credits will drop the cost of Medicaid’s $500 billion dollar cost.

    Devon, I’m on WHO radio, the Reagan Station, in a few minutes explaining Republican Reform. Listen online at 11:07 AM. Here is the email I sent my good friend Jan Michelson the host:

    Hi Jan,

    It was good talking with you today and I have been praying for you.

    Republican Reform is better than Obamacare. Republican’s age-based tax credits to purchase personal, portable and permanent Individual Medical (IM) insurance is better than Obamacare’s income-based tax credits. Obamacare tax credits are available only to singles earning $12,000 to $49,000. Married couples are cut off at $64,000 earnings. Republican tax credits are age-based so everyone qualifies. The tax credits are less expensive for the Federal Government than the exclusion for employer-based health insurance.

    With Republican reform America will switch away from employer-based health insurance to personal. portable and permanent Individual Medical (IM) insurance.

    Changes that happen with Republican Reform.

    1. When we lift the cost of insurance off the backs of American employers the economy will soar like never before.

    2. All products and services will drop in cost because because their embedded cost of employer-based insurance will be removed.

    3. Local taxes will drop because the largest expense for States, Cities and Counties is employer-based insurance.

    4. States with income tax win. Iowa’s tax collection grows because the high cost of employer-based insurance is no longer an exclusion.

    5. Medicaid’s $500 billion dollar cost is reduced. 1/3 of all Californians are on over-priced Medicaid.

    In short – Republican Health Care Reform will Make America Great Again!

    at 11:07 AM introduction. I have had Ron Greiner on the show before going way back when he explained Medical Savings Accounts now called Health Savings Accounts. Today we are going to talk about Republican Health Care Reform, hello Ron —

  2. Lee Benham says:

    Ron,
    I listened to the broadcast. I think you did a good job explaining how individual age based tax credits are not anything like ACA tax credits. Nice example of the 50 year old couple utilizing the HSA to gain $20,000 in tax credits. Some of the things you said about employer based benefits were so far over the heads of the host and listeners was actually amusing. You don’t often hear 10 seconds of silence from a host because he has no idea how to respond to a statement. The only thing I would further explain is people might have gotten the impression that age based tax credits didn’t kick in until they were 50.
    I think you needed to explain what the age based tax credit is a little more so listeners would have more intelligent questions.
    Over all B+. hearing you talk helps me better understand some of the things you write.
    Good job.

    • Ron Greiner says:

      Thank you Lee. It was a race with the clock because the 1/2 hour show is really just 22 minutes when you take out the commercials. Jan, the host said, “I hope the Republican politicians are listening today so they will be able to explain “Trumpcare” at their Obamacare town hall meetings.”

      I did get in there, “Every FAKE NEWS newspaper in America is selling insurance to their own employees that they lose if they get so sick that they can’t work so the newspapers can’t write a story and explain what they are doing.” Then Jan said, What do you mean?” So I said, “The Des Moines Register is selling insurance to young female employees that if they get ovarian cancer and become too sick to work the Register slams them on a short-term COBRA for insurance termination. Trust me, losing your health insurance 18 months into your cancer is depressing at best and deadly at worst! If the Register wrote about what they have been doing to their own employees since World War 2 they would get a Pulitzer Prize!” (Then there was a long pause – you are correct Lee) Finally Jan did say, “You are right that the newspapers are not explaining TrumpCare.”

      I blew it at the end when the callers were calling in asking if you can get this now and I didn’t say, “NO – we have not passed TrumpCare yet.” So I’m down grading your B+ to a B for that interview.

  3. Ron Greiner says:

    To become President of the United States the doorway was thru Jan Mickelson at WHO Radio in Des Moines, Iowa. Jan got to interview every Republican candidate several times and I turned Jan into a tax-free MSA freak before President George W. Bush ran the 1st time in 2000. Jan is really, really smart and he always clobbered these politicians. Jan had a stroke and missed this last election for President but Jan destroyed Mitt Romney the election before that. Jan was attacking Mitt and during the commercials the show was being video taped and Mitt started shooting his mouth off at Jan and Jan let him have it, both barrels. It is the funniest thing to watch when Jan told Mitt Romney he knew more about being a Mormon than Mitt.

    Here is Jan and Mitt the short version – 2 minutes

    https://www.youtube.com/watch?v=G5sXcdiL1wE

  4. Devon Herrick says:

    The private sector has developed tools to combat insurance fraud. Medicare is slow to adapt and Medicaid is worse because someone else (the feds) are paying 50% to 83% of the cost of fraud.

    • dennis byron says:

      There is an interesting demonstration of what you claim in the earlier version of these GAO “reports” (which are really just compendiums of departmental reports — in other words, the Medicare and Medicaid data comes from CMS, not from a GAO audit). According to the detail underlying the CMS data released in 2016 (published Feb 2016 I think so presumably for 2015):
      — Fee for Service Medicare had a 12% gross improper payment rate and an 11% net improper payment rate (some improper payments are in the Trust Fund’s favor or the money is returned)
      — But for public Part C Medicare health plans, the gross improper payment rate of 9% netted out to only 4%
      — And the big winner was public Part D of Medicare (standalone self-administered drug coverage) with only a 4% gross rate and a 2% net improper payment rate

      (Also note that improper payments are not the same as fraud, waste and abuse.)

  5. Barry Carol says:

    Ron,

    With respect to #1 and 2, I think it’s highly likely that any savings employers realize from no longer having to provide ESI will be shifted to higher wages instead so total compensation will remain roughly comparable to what it was before. Thus, their profits won’t rise and the price of their products and services won’t fall.

    #3 – The biggest expense for states is education, both K-12 and higher education. The next biggest is Medicaid and the next is law enforcement, including the prison system. Those three functions account for roughly 85% of spending at the state level. While ESI is a big expense at the town, school district and county level, salaries are a significantly larger expense.

    #5 – Roughly 65% of Medicaid spending is on the aged, blind and disabled (ABD) population. Children will likely remain covered by the CHIP and women of childbearing age will have to bear the cost of maternity coverage assuming they can pass underwriting. Savings will be relatively small as a percentage of total Medicaid spending.

    Finally, once again and as usual, you said nothing about the need for high risk pools for the significant number of people who can’t pass underwriting. Insuring them will be pretty darn expensive on a per person basis and we hear nothing from you about how much that might cost and who will bear that tax burden.

    Sure the healthy folks will be better off with age-based tax credits than they are under the ACA but what about the unhealthy and already sick? You say nothing about them because you have nothing to offer them in the individual Medical (IM) underwritten market.

    • Ron Greiner says:

      Barry, you wrote, “you said nothing about the need for high risk pools.” That is not true. We need High Risk Pools (HRP) for goofballs on dangerous over-priced employer-based health insurance who get too sick to work and are terminated off insurance so the employer-based insurance companies can laugh all the way to the bank. HRPs will be about the same cost as Obamacare now but the healthy will have their premiums drop by over 50% which can really add up fast over a lifetime in a tax-free HSA invested into mutual funds.

      Also, 1/3 of all Californians are on over-priced and dangerous Medicaid and not all of these beach boys are your so-called the aged, blind and disabled (ABD).

      Barry, too bad you didn’t call into the show because arguing with you is like taking candy from a baby, a blind baby. Here, listen to the show, remember the host, Jan, has had a stroke:

      http://whoradio.iheart.com/onair/mickelson-in-the-morning-7738/why-is-an-msa-better-than-15588823/

      • Allan says:

        Ron, Barry does not realize that there are the known and the unknown ill. He only cares about the known ill many of which have lost their employers insurance, but to that he turns a blind eye. He also turned a blind eye to those that had good insurance and were placed on Medicaid. Finally he forgets that the number of unknowns is greater than the knowns, but he doesn’t seem to care that much about them.

  6. Jimbino says:

    “Medicare, Medicaid, Veterans Health At High Risk For Fraud, Waste, Abuse” shows the infelicitous “at risk for …” rearing its ugly head again. In English, we say,

    a chance of rain for three more days
    a probability of success
    a risk of fraud
    the certainty of taxes.

  7. Ron Greiner says:

    NCPA TRUMPCARE ALERT: This just in from FAKE NEWS – FOX News: 55-year-old Brenda Buttner, host of Bulls and Bears, has died because of cancer.

    Just this week at Rep. Gus Bilirakis (R-FL) Obamacare town hall I walked up to the FAKE NEWS Fox News TV crew and asked, “If you guys get too sick to work because of cancer can you keep your FOX News employer-based health insurance?” The camera man said, “I don’t know.” But the stupid on air reporter named Evan Axelbank said, “YES, of course!” So I asked again, “Are you saying you can keep your employer-based health insurance if you get a head full of brain tumors and are too sick to work?” He looked at me with that dairy cow look in his eyes and said, “OK, I know what you are trying to do.” I said, “What?” Evan said again, “I know what you are trying to do, get me fired.”

    Then I watched Evan interview Rep. Gus Bilirakis and Gus said Republicans want age-based tax credits and Evan started screaming, “That’s Obamacare, that’s Obamacare.” After the interview I told Evan too bad he was so uninformed because people need better questions asked. Evan said, “I think I did a good job.” I said, “NO Evan – YOU SUCKED.”

  8. Ron Greiner says:

    NCPA TRUMPCARE ALERT 2: This just in. Florida Blue, the giant monopoly and the only insurance company in 70% of Florida counties can’t service their Obamacare clients, unreal Barry. Florida Blue Cross gives more to politicians in Florida than any other entity. Blue Cross just buys politicians of both political parties.

    “They over bill me every month and tell me I haven’t paid when I actually have. Then they deny claims until I call and verify that I have in fact paid. Every. Single. month,” one person wrote in a Facebook post.

    “If this was any other company, I would have been gone,” said Mouras, reflecting on her frustrating customer service phone experience. “But I couldn’t go anywhere, because the open enrollment period is over.”

    “Florida Blue is apologizing to customers who continue to have issues with their Obamacare plans.”

    Got the BLUES? Paying way too much with NO SERVICE?

    http://www.orlandosentinel.com/health/os-florida-blue-obamacare-glitches-20170223-story.html

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