It seems to be a well-established technique to first declare an increase in Social Security benefits and then a few days later announce healthcare costs have gone up which will result in increased Medicare charges to be deducted from Social Security; hence, what the right hand giveth, the left hand taketh away.
To stir the pot a bit, I refer to an Associated Press article (10/17/2011) by Elli Kennedy who points out that Medicare fraud is estimated at between $60 billion to $90 billion per year. "Medicare fraud," according to Kennedy, "has grown so lucrative and so easy that drug dealers and organized crime rings are tapping into it . . . because it affords greater payoffs and carries shorter prison sentences than drug trafficking or robbery."
The Medicare program began in 1965 by Congressional mandate and provided for private contractors to process and pay claims. It was not until 1996 that Medicare hired a separate set of contractors to seek out fraudulent claims. This has become known as the "pay and chase" method and is alleged to be a boon for criminals, allowing them weeks of lag time to bill for fraudulent claims, receive payment and skip town before authorities catch on. But there's more. It turns out the fraud unit is also broken down into "Contractor A" who inspects the provider place of business and "Contractor B" who ultimately decides whether to revoke a Medicare license. Sometimes one subcontractor, without first-hand knowledge of the case or the necessary medical expertise will overturn a suspension made by the other contractor who had direct evidence of fraud. Here, once again, is the guiding principle that the right hand does not know what the left hand is doing.
A revocation does not necessarily lead to a criminal investigation - that's also a separate process. If a provider appeals a revocation, this leads to an independent third party or hearing officer who makes another ruling. If the provider disagrees with that decision, the appeal can be kicked up to an administrative law judge. According to this article, it's at this point that truly fraudulent providers tend to walk away - they often simply obtain a new license under an associate's name and keep right on operating. But even if the appeal goes forward, Medicare does not send lawyers to defend the revocation decision so the judge hears a one-sided story thus guaranteeing a government loss. In the event of an actual indictment, Federal Authorities seize assets, but what's left is usually only a fraction of what was taken.
Medicare ratepayers should be outraged at any increase in premium costs while Medicare fraud continues virtually without restriction.
Possibly, the reader will recall that President Obama fought for and paid a high political price to obtain a "National Health Plan". The center piece of this Healthcare Plan was that enforcement and elimination of Medicare Fraud would help pay for the anticipated costs. It is equally obvious that Medicare's treatment of fraud is not working!
Gee Mr. President, since the Attorney General's Office comes under your authority, and since you promised to put an end to Medicare fraud, why are these crooks not being prosecuted under the direction of Federal Authorities instead of private contractors?