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The Tragedy of Medicare Fraud: Opportunity Cost October 6, 2008

Posted by Who? in Business, Health, Politics, Random.
Tags: , ,

Just came across a post in USA Today- “Rampant Medicare Fraud Suspected in Miami”. True to its government-run form, there seem to be some problems surfacing in certain Medicare paid services (Home Health Care) across the country; it seems to be particularly out of control in Florida.

“Miami-Dade County is on track to cost Medicare a projected $1.3 billion for home health care services this fiscal year, up 1,300% in just five years, government data show. Investigators suspect that fraud is helping to drive the increase because the population of Medicare beneficiaries in the county grew only 10.2% between 2004 and 2007, the latest government data show.”

This is so outrageous that you almost can’t help but laugh. How does 1300% growth go unchecked? How can the administration look at that and not say “Wait a minute- that seems a little high…”? Remember, that $1.3 billion is for Miami-Dade County ALONE. The financial waste of that county alone is staggering, but the real tragedy is the economic cost– the cost of wasted opportunity.

Let’s say that 25% of that $1,300,000,000 is the result of fraud- who knows what the actual number is but it’s safe to say that a large percentage of 1300% growth is the result of fraud. Twenty-five percent of $1.3B is 325 MILLION dollars. That is almost a 1/3 of a BILLION dollars flushed down the toilet in ONE YEAR. That is the real tragedy of federally administered health care.

Think of what an innovator could do with $325 million. Think of what an innovator could do with the interest alone on a principal balance of that size. And, again, keep in mind that this is the waste from one county and one tiny portion of the Medicare budget.

Opportunity of the Day: a private contracting firm that protects against fraud in Medicare services.

Eliminate the waste and put it in the hands of people that can create value through innovation.  It’s not rocket science.



1. Dr Barry L. Marks, DC - October 6, 2008

Good points… as a doctor who has opted out of Medicare (that’s a completely different story and would make your head spine) not only is there fraud and abuse on the part of providers, but you should see the lists of financial and regulatory abuses by Medicare itself. It’s a terribly flawed government run system that needs to be put to sleep.

The Fed Govt cannot manage porgrams like this…National Health Care? Terrifying!

2. sasha - October 7, 2008

One must wonder what the ex-majority Leader’s family business really stole!
The U.S. District Court of the District of Columbia has approved HCA Inc.’s recently signed agreement with the Department of Justice that settled the federal government’s fraud litigation of the hospital chain by addressing the issues of cost reports and physician relations.

The agreement, originally announced in December, calls for Nashville-based HCA (NYSE: HCA) to pay the DOJ $631 million as well as interest of 4.5 percent that began to accrue in February.

HCA has also paid the Centers for Medicare and Medicaid Services $250 million as part of an earlier agreement to resolve all Medicare cost report, home office cost statement and appeal issues between HCA and CMS.

3. John Schilling - October 7, 2008

If you really want to know more about the HCA settlement you need to read “Undecover: How I Went From Company Man to FBI SPY and Exposed the Worst Healthcare Fraud in U. S. History. I was the whistleblower and in my book I tell the real story.

John W. Schilling
Author – Undercover

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