How Much Does Medicare Fraud Cost Taxpayers?

[somarco]

Medicare fraud costs taxpayers an estimated $58.5 to $83.9 billion per year. While this is a significant amount, it may be a substantial underestimate as it excludes medically unnecessary procedures, according to a recent study in JAMA.

Elaboration:
Estimates Vary:
Different sources offer slightly different estimates for the annual cost of Medicare fraud, but they consistently point to a multi-billion dollar loss for taxpayers.

Impact Beyond Financial:
Medicare fraud also has a negative impact on beneficiaries, causing stress, delays in care, and potentially affecting their health.

Types of Fraud:
Medicare fraud can take many forms, including billing for services not provided, misrepresenting diagnoses, and offering kickbacks for patient referrals, according to the Senior Medicare Patrol.

Efforts to Combat Fraud:
The Department of Health and Human Services (HHS) and other government agencies work to combat fraud, investigate cases, and recover funds.

Improper Payments:
Beyond fraud, Medicare also faces losses due to improper payments, which are payments made in an incorrect amount or that should not have been made at all, according to the GAO

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2753426

 

[annon123]

Medicare fraud costs taxpayers an estimated $58.5 to $83.9 billion per year. While this is a significant amount, it may be a substantial underestimate as it excludes medically unnecessary procedures, according to a recent study in JAMA.

Elaboration:
Estimates Vary:
Different sources offer slightly different estimates for the annual cost of Medicare fraud, but they consistently point to a multi-billion dollar loss for taxpayers.

Impact Beyond Financial:
Medicare fraud also has a negative impact on beneficiaries, causing stress, delays in care, and potentially affecting their health.

Types of Fraud:
Medicare fraud can take many forms, including billing for services not provided, misrepresenting diagnoses, and offering kickbacks for patient referrals, according to the Senior Medicare Patrol.

Efforts to Combat Fraud:
The Department of Health and Human Services (HHS) and other government agencies work to combat fraud, investigate cases, and recover funds.

Improper Payments:
Beyond fraud, Medicare also faces losses due to improper payments, which are payments made in an incorrect amount or that should not have been made at all, according to the GAO

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2753426

Locally one of the ER's has been outsourced to a for profit. They order unnecessary tests so they can upcode physician time/effort. They have a "mandate" to have $1200 in billable changes on every patient who walks through the door. They charge for IV's not given and the hospital side will indicate no charge for an IV which there would be if they had one. When calling Medicare it is hard to get them to look into fraud like that with just one patient reporting even though it is what the ER does all the time. So part of this is medicare's fault too. In either case somehow this needs to stop.

 

[somarco]

Single case complaints are too labor intensive to investigate. Same thing happens with DOI "tips".

If they get enough complaints about the same situation and/or same provider, an investigation is launched.