Let's Eliminate Healthcare Fraud
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Insurance Fraud News
The Washington Post recently reported a federal investigation into 7 companies involved in a scandal to overbill Medicare by about $2 billion. It is not the first time. Good news the feds are on it. People don’t get away with defrauding the government for long. The consequences are real, hefty fines and jail time.
In fact, the one I like to reference involved the Senator from Florida, Rick Scott. He was CEO of HCA (at the time Hospital Corp of America), He oversaw one of the largest Medicare/Medicaid frauds ever. In fact, HCA was forced to give back $2.3 billion in the 1990s. Rick Scott was fired.
According to the Centers for Medicare & Medicaid Services (CMS), the Medicare Fee-for-Service (FFS) improper payment rate for 2023 is 7.38%., about $31 billion. This is the seventh year in a row that the rate is below the 10% threshold for compliance. In 2020, CMS reported an improper payment error rate of 5.42% for Medicare Advantage Plans, or Medicare Part C.
Another important note is that this was fraud against traditional Medicare. Medicare Advantage companies bilk the US for between $88 billion and $140 billion in 2022 according to a recent report released by Physicians for a National Health Plan. The PNHP report includes defrauding techniques not included in the CMS report such as favorable selection and deselection of beneficiaries, and the maniplulation of benchmarks and bonuses.
However, looking at the commercial industry we find, according to Taxpayers Against Fraud,l private health insurers pay $1.2 trillion per year, accounting for 31 percent of total healthcare spending. With experts estimating that as much as 20 percent of healthcare spending is wasted due to fraud, this means that private insurers may be doling out approximately $240 billion every year to fraudsters. Ordinary patients ultimately bear these costs, as insurance companies increase their premiums to account for the amount they waste due to fraud.
Did you catch that? Medicare was cheated $31 billion, private insurers, $240 billion. When it is the federal government that is cheated, they call in the FBI, when it is private insurance, they just increase premium. I’ll take the feds, please.
ACTION Medicare Needs Our Help
We just saw another Medicare fraud. In addition, most of biggest Medicare Advantage (part c - private insurance - not Medicare) providers are under federal investigation for overbilling to the tune of billions.
Here is a request from Physicians for a National Health Plan. Ask your Senators and Member of Congress to sign on to a letter to the Center for Medicare and Medicaid Services circulating in Congress from Sen. Elizabeth Warren and Reps. Pramila Jayapal, Rosa DeLauro, and Jan Schakowsky. The letter asks that CMS act to
Remove barriers to medical care such as pre-authorization requirements and limited provider networks;
Rein in rampant overcharging of taxpayers by Medicare Advantage plans (PNHP’s recent report estimated excessive payments of between $88 billion and $140 billion per year); and
Improve the traditional Medicare program by reducing premiums and out of-pocket costs, and by adding benefits like dental, hearing, and vision.
You can send the email by clicking here.
Micro Hospitals Coming
According to the Philadelphia Inquirer, Southeastern Pennsylvania will get its first micro-hospitals — facilities with small emergency departments and 10 inpatient beds for people who are not seriously ill — as ChristianaCare and Lehigh Valley Health Network seize upon an efficient option for expanding into the Philadelphia market. Also called neighborhood hospitals, the model is designed to fill coverage gaps in areas that can’t support a full-scale hospital, while allowing health systems to expand their reach into more distant communities.
Rural Emergency Hospitals - Florida
With supporters pointing to a need to ensure health care access in rural areas, Florida House and Senate committees Thursday moved forward with bills that would create a new category of “rural emergency hospitals” in the state. The House Health & Human Services Committee approved the House version of the bill (HB 309), sponsored by Rep. Jason Shoaf, R-Port St. Joe, with the measure now positioned to go to the full Florida House.
RESOURCES
Healthcare Advocacy (Us)
Website
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
By phone: (202) 224-3121
By email: democracy.io
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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Q: When a huge company fires you as CEO for overseeing a $2 billion fraud, what do you do?
A: You run for the US Senate — and win.
Is America a great country, or what?!
(p.s. ...Not quite great enough to give 330+ million people basic healthcare as a right — while saving trillions of dollars per decade and a quarter million lives. But that's another story. )
RJ Barnabus charges $602 for a dr to give test results in a 3 minute phone call? Since when does one pay for test results from a bone scan? When I go for base line results doesn’t my copay entitle me to my results? My mammogram test sent me a letter… no extra charge… my on gyn charged me $10 while charging taxpayers $602 ( Medicare) when I called for results of a bone scan I never received. Fraud?