[Snow-i]

Can somebody who supports the public option please explain to me how, given the "500 billion in waste fraud and abuse" that has until now been a low priority for our government, the public option will not run into more of this same "waste, fraud and abuse" but on a significantly larger scale?

They've already shown us their promises and words about "waste fraud and abuse" mean absolutely nothing, why should we entrust them now with an even greater responsibility?

[ghporter]

"Low priority?" Hardly. There are scores and scores of Medicare fraud convictions you can look up, some from a LONG way back. It just takes a LOT of time to put together a case, in part because it's possible for such fraud to be widespread in a city, a region, even a number of states, all based on the same bad guys and their actions. Most fraud is at the "practice level," where some doc figures he can skim more cash by lying to Medicare. Turns out that this paperwork that "nobody ever checks" really IS checked, rather thoroughly. Which is one of the problems with Medicare: the potential for fraud means that there are a LOT of people reviewing cases, often people who don't know a suture from a scalpel. This slows things down and means that valid claims get returned because someone doesn't understand the notes, or the clearinghouse worker uses one definition for something while the actual practicing health care world uses a different one.

This is a major reason that Medicare reform is VITAL. Making it VERY hard to even try to defraud Medicare (electronic documentation filed with the clearinghouse directly is one way to do that), and removing several layers of screening would save tens of millions every month. FORCING regular insurance companies to justify their use of Medicare standards (written to manage care mainly of adults and the elderly) for juveniles and infants would be another big help.

[Snow-i]

Originally Posted by ghporter 

"Low priority?" Hardly. There are scores and scores of Medicare fraud convictions you can look up, some from a LONG way back. It just takes a LOT of time to put together a case, in part because it's possible for such fraud to be widespread in a city, a region, even a number of states, all based on the same bad guys and their actions. Most fraud is at the "practice level," where some doc figures he can skim more cash by lying to Medicare. Turns out that this paperwork that "nobody ever checks" really IS checked, rather thoroughly. Which is one of the problems with Medicare: the potential for fraud means that there are a LOT of people reviewing cases, often people who don't know a suture from a scalpel. This slows things down and means that valid claims get returned because someone doesn't understand the notes, or the clearinghouse worker uses one definition for something while the actual practicing health care world uses a different one.

This is a major reason that Medicare reform is VITAL. Making it VERY hard to even try to defraud Medicare (electronic documentation filed with the clearinghouse directly is one way to do that), and removing several layers of screening would save tens of millions every month. FORCING regular insurance companies to justify their use of Medicare standards (written to manage care mainly of adults and the elderly) for juveniles and infants would be another big help.

So if this is the case, then how does Obama plan to cut 500 billion of such unscrupulous behavior just like that? And why wasn't it done sooner?

[ghporter]

Good question on the first part. I thought I explained the second part-lots of investigation is needed to verify fraud and who's been doing it. If the pres can find a way to streamline the paperwork, that should make it much easier to see who is cheating, which should also streamline the investigation/prosecution issue.

[Snow-i]

Originally Posted by ghporter 

Good question on the first part. I thought I explained the second part-lots of investigation is needed to verify fraud and who's been doing it. If the pres can find a way to streamline the paperwork, that should make it much easier to see who is cheating, which should also streamline the investigation/prosecution issue.

Indeed...but why is this not his top priority? Wouldn't this be a great way to cut deficit spending, stimulate the economy, and generally better our country fiscally?

I guess my question really boils down to...Why doesn't he cut all this waste, fraid, and abuse and then come talk about healthcare? Show us a system that works before selling us a bigger one.

If its such a messed up system, why should he not have to prove that the feds can run a decent system without running into such rampant fraud and abuse? Wouldn't that win many hearts and minds in this debate? Instead he's trying to shuffle this through without detailing or performing a fix for the current, broken, system.

I'd be much more open to hearing his arguments if he could fix whats on his plate before ordering dessert.