Robert E. Shlafer wrote: "One thing for sure, it (the Massachusetts
plan) will require good financial oversight/monitoring if Medicare is
any example."
Unfortunately, the very size of the Medicare program makes it open
season for outright fraud as swell as rampant abuse (such as ordering
unnecessary tests, equipment, or therapy). In a 2005 report, the
General Accounting Office reported that an estimate 10 percent of
provider claims were fraudulent. At the same time, the retired chief
investigator of Medicare fraud in New York claimed that in 2004, $18
BILLION or *40 percent* of provider claims were either fraudulent or
abuse. If the same were true nationally, that would mean that $136
BILLION went for fraud or abuse.
I became interested in Medicare fraud last year when I discovered that
the "diabetic shoes" that I was provided with under Medicare were part
of a fraudulent nationwide scheme involving the manufacturer and
podiatrists. After I received them, I learned that the podiatrist
charged Medicare $340 for the shoes and supposedly "special" inserts.
In my own investigation, I learned that earlier in the year, the shoe
company had been raided by the FBI seeking evidence that it had been
selling shoes and inserts that it knew did not meet Medicare
requirements. No charges had yet been filed at that time, but my shoes
and inserts were clearly not to requirements. Before turning my
evidence over to the FBI, I questioned the doctor who was highly irate
that a simpleton patient should question him. Ironically, he blatantly
gave me paperwork from the company that buried them even deeper.
Unfortunately, everyone from investigators and prosecutors to the GAO
agree that the problem is that Medicare to far too massive and complex,
while at the same time "lightly policed". Oh, yes, any my shoes did not
fit!
Buster
|