60 Minutes piece on healthcare fraud last night

[vash1012]

Did anyone see the 60 minutes piece on the health management firm that was being accused of pressuring doctors to admit patients. keep them longer, and do more tests despite medical need so they could make more money mostly from medicare? A friend remarked during it that this kind of thing is why we need socialized healthcare. I argued that, if you notice, the company was primarily defrauding medicare and medicaid and not private insurance companies. I said this was probably because private insurance companies have a profit incentive themselves so they are more inclined to put a stop to this sort of thing than a federally controlled health care insurance system who typically operates on a system wide scale with less micromanagement of individual hospitals. So lets discuss this. Why is it that medicare and medicaid are typically what is defrauded and does this mean that a government controlled health care insurance could not work to control costs unless hospitals and doctors offices where also made government institutions? Is it even possible in America to turn our healthcare system into an entirely socialized system where all or most healthcare workers are governement employees?

 

[ttwtt78640]

Insurance companies have an excellent incentive to prevent fraud - their profit is reduced. Gov't, on the other hand, has no such incentive, actually the opposite - the more they spend the more their power, pay and staffing grows. Why did PPACA "private insurance driven system" not include "privatizing" (incorporating) Medicaid, Medicare and VA medical care? The gov't answer seems always to be keep what they have and add on more layers. I still think that PPACA is simply step one in scheme to get to a gov't run UHC system - designed to make the public demand it by destroying the current private, for profit, system that we now have.

 

[Fisher]

They are making improvements, but at a price to patients. I hear a lot of seniors complaining that instead of going to the doctor every 3 or 4 months, they now have to go several more times because of limits being placed on procedures like bloodwork.

 

[vash1012]

They are making improvements, but at a price to patients. I hear a lot of seniors complaining that instead of going to the doctor every 3 or 4 months, they now have to go several more times because of limits being placed on procedures like bloodwork.

Yes, thats interesting. I work in a hospital so I don't see much on the outpatient side, but that was my point about these large federal programs typically addressing a problem with system wide changes. They'll limit how many tests/procedures for everyone instead of targeting fraud. I don't mean they do this maliciously, but being so large, its about all they can do.

 

[Dittohead not!]

I saw it.

It is not at all surprising that a hospital would try to enhance profits by increasing the numbers of paying customers admitted. What the 60 minutes spot showed was the tip of the iceberg, I'm sure, as health care providers are incentivised to give the maximum care to Medicare patients, as well as to those covered by group insurance plans, so as to collect the maximum profits from payers. What would be surprising is a private, for profit, health care provider that didn't maximize services to patients whose care is being paid for by a third party.

Our health care system, even more than our bloated federal government, is bankrupting the country.