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Author: TMFPMarti Big funky green star, 20000 posts Home Fool Add to my Favorite Fools Ignore this person (you won't see their posts anymore) Number: of 19257  
Subject: Re: Wharton Biz School looks at Medicare Date: 5/19/2009 6:16 AM
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I do believe that if people were rewarded to doing a better job than other people, more would be accomplished. I do not consider identifying and reporting people or companies commiting fraud under medicare Law enforcement. I consider it part of their job.

Me too. I also think of it as law enforcement, no doubt because of my IRS experience. An example would be the "funny boxes" in the processing centers. The people who work there are basically paper pushers. They have production quotas and must keep stuff moving. But part of what they're required to do is scan returns for certain markers of a fraudulent return and, if they see one, yank it from the pipeline for further examination. I couldn't swear to it, but I strongly suspect that an employee who has an especially good eye for it gets rewarded. The IRS is full of people with dual service/enforcement roles.

I hadn't followed the thread and was just responding to what I thought was a comment about people who actually investigate Medicare fraud. I went back to see what had prompted your comment and see that we're in "waste, fraud, and abuse" (WFA) territory. Nixon was President when I started, Clinton when I retired. Every administration had at least one WFA initiative, as well as at least one paperwork reduction initiative about which we received countless memos. You weren't talking about real investigators, whom I think we'd both call law enforcement, you were talking about the people who process claims. My apologies for the misunderstanding.

Here I do have a little knowledge about Medicare from my time handling my parents' finances, including the incomprehensible medical bills, which included:

1. Original charge
2. Medicare adjustment
3. Medicare payment
4. Secondary insurance adjustment
5. Secondary insurance payment
6. Patient payment due

Of course, their main provider, a group practice that included their internist and several specialists, didn't group these on the bill. Rather, they just listed everything in journal entry according to their books, with nothing tying everything together except a reference number so you could see that the dust had settled on a particular service and it was time to pay.

Never given to false modesty I'll note that I'm smarter than most people and worked with numbers my entire life. In the early days I just waited until I got two bills from the provider in the same amount, but as things heated up it became impossible to figure it out without putting everything on a spreadsheet. Sorry, I digressed from your point into the general area of resources directed to accounting rather than treatment.

Perhaps again because of years of hearing about bureaucrats sitting around doing nothing I assume you think that there are legions of gummint minions shoving these claims along while yakking about their love lives. These people are not government employees, they are from the [cue choir of angels] private sector, which every Republican administration tells us does everything better, and every Democratic administration tells us threatens the republic. The Feds contract with companies to provide claim processing.

We're back to where I know nothing about Medicare. If I were writing those contracts there would be incentives for flagging potential fraud for real-life gummint law enforcement people to investigate, but I don't know whether the existing contracts do so. I also never saw anything funny in my parents' bills, so I have no experience making reports.

With apologies to pauleckler, whom I respect, I don't think Medicare FWA, while it certainly exists, is much more than a pimple on a gnat's butt when it comes to the overall problem of paying for Medicare. Nor do I think funding Medicare is the problem. Rather, I see it as a symptom of an unsustainable overall medical care delivery system, which starts at training service providers and ends at end of life decisions.

Phil
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