What's Driving The Enormous Medicare Fraud?

Comparison of Medicare fraud losses to other expenses in the federal budget (From AARP Bulletin, April, p. 10-11)

In my book, 'The Elements Of The Corporatocracy',   I noted that when a genuine social insurance program exists in a predatory capitalist society it is in constant peril from parasites, scammers, con men, assorted grifters and corporate predators.  Thus, it is no surprise that both Social Security as well as Medicare, the two most viable current social insurance programs, are under sustained attack.

In the case of the first, we learned from one website ('Lifelock'):

"There are a lot of ways to commit Social Security fraud. Not all of them are obvious. Fraud often occurs anytime someone receives Social Security payments they’re not entitled to. The Office of the Inspector General of the Social Security Administration (SSA) cites a few common examples:

• Hiding work activity while receiving disability benefits.
• Getting Social Security benefits for a child not under your care.
• Failing to let the SSA know that a beneficiary has died and continuing to receive and cash the checks sent to the deceased.

Consider this: About 6.5 million people who had active Social Security numbers in 2015 appeared to be at least 112 years old, a government audit found. The real number of living Americans more than 112 years old is closer to five."

In the case of Social Security the yearly losses from fraud are estimated to be in the billions of dollars. But this may still be an order of magnitude less than the fraud losses ($60 b) exacted on Medicare, as reported in the most recent AARP Bulletin ('Medicare Under Assault', April, p. 10)  Reading through the assorted strategies vermin use to defraud the program is enough to make a citizen vomit.  Probably the most odious, in my opinion (p. 20),  was the "recruiting" of homeless people to create fake patients.  These hapless pawns are then trotted into doctors' offices to be approved for services and the physicians themselves may or may not be in on the scheme  In return for signing off on falsified documents, the phony patient is paid a small amount (e.g. $20- 30) for showing expensive care never delivered.  As the segment notes: "Homeless shelters are fertile ground for recruiters involved in this type of fraud."

Well, I wouldn't go so far as to call them "recruiters" - they are bugs, vermin - who merit extermination, just like roaches.  Am I being too "hard", too "judgmental", too "inhumane"? Nope, I am calling it exactly as I see it: anyone who preys on a homeless person, giving him or her chump change to help undermine a health insurance system that serves tens of millions,  is a feral rat who deserves to be put down.   Let's further note, for emphasis, all these modes of fraud undermine the ability of real patients to find treatment - which may lower reimbursement rates for doctors and facilities - and even push some providers to stop accepting Medicare. 

The assorted other modes of  Medicare fraud include:

1) Medical identity theft:

Here, the scammer or thief manages to get hold of your Medicare card or the beneficiary number.  This can then be used to access medical services under your name - say to get treatment, devices or medicines. This interference can also impinge on your medical care (say if the wrong treatment is administered because providers believe you are the frauduter)

2) Upcharging:

This is also known as "up code billing" and it occurs whenever Medicare is billed for a more expensive device or procedure than the one you actually received.  This is why seniors need to be vigilant in checking Medicare statements, especially the CMS Summary sheets. Any discrepancy noted ought to be followed up by calling the doctor to rule out an innocent billing code error.

3) Phantom billing - double dipping:

These fraudulent tactics would also show up on one's Medicare statements.  "Phantom billing" is charging Medicare for services not delivered. Double dipping is filing duplicate claims for one service or procedure. If not caught and rectified they can hurt futur health coverage.

4) Fake freebies:

These are used by scammers to sucker the unwary into receiving devices or services,  e.g. wheel chairs, walkers, back braces you may not need. They're usually offered at "no cost to you"  but Medicare is billed for them. Often they are inferior products, e.g. walkers that collapse.

5) Prescription fraud:

In this fraud, Medicare crooks take your Medicare number and use it to fill prescriptions, e..g. for hydrocodone, then sell them on the black market.  Very often people discovere they have become a victim when their prescriptions are denied.

It follows from all that's been discussed that eternal vigilance has to be the motto of every Medicare recipient. It is in the self-interest of all of us to look over every statement carefully, and guard our Medicare cards and numbers as zealously as we would our car or house keys.