Wednesday, November 04, 2009

$60 billion in medical fraud versus $8 bil in profits

The money in profits for health insurance companies is small compared to the money taken in fraud from Medicare and Medicaid.
All it took to bilk the federal government out of $105 million was a laptop computer. From her Mediterranean-style townhouse, a high school dropout named Rita Campos Ramirez orchestrated what prosecutors call the largest health-care fraud by one person. Over nearly four years, she electronically submitted more than 140,000 Medicare claims for unnecessary equipment and services. She used the proceeds to finance big-ticket purchases, including two condominiums and a Mercedes-Benz. Health-care experts say the simplicity of Campos Ramirez's scheme underscores the scope of the growing fraud problem and the need to devote more resources to theft prevention. Law enforcement authorities estimate that health-care fraud costs taxpayers more than $60 billion each year.... Investigators and prosecutors trained their focus on Miami after noticing two troubling patterns: · HHS investigators discovered that nearly half of 1,581 medical equipment companies they visited in the Miami area did not comply with basic Medicare requirements to be open during scheduled hours and to have a telephone number. The inspector general and the Government Accountability Office have flagged weak oversight of these kinds of suppliers for a dozen years, according to congressional testimony... Authorities say the strategy is working. They point to a $1.75 billion drop in Medicare claims in Miami since the operation began a year ago. But even government officials hope for a more comprehensive solution.
$60 billion in fraud. Versus $8 billion annual profits for insurance companies - all of them. Theses are large companies serving 100 million people. Those profits are not large for that size of operation. Isn't $60 billion stolen a real problem? Via Weekly Daily Standard

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