Health Insurance???
- Thread starter djv
- Start date
Keep railing against health care reform and maybe it will go up another 35% next year.
- Feb 26, 2001
- 13,593
- 164
- 63
You are going to have to wait until Monday for an answer. Rush doesn't work on the weekends.
The government titty is wrapped up in a big ol' brass bra for us! With $40,000 earned in the last calendar year, we are considered too wealthy for the poverty ratio. We are damned by the fact that we did save for the unpredictable and have/had >$2000 in liquid assets on which we have been able to maintain. Perhaps I should start drinking and maybe we can get in under the "substance abuse" loophole?
:shrug:
in a nutshell,there are points of view other than"o.k. with the status quo" and "want the bill as presented"......
over 80% are satisfied with their insurance/healthcare.....scrapping the entire system in favor of an incremental govenrment takeover that puts private insurers out of business and aims toward single payer just isn`t acceptable to many of us....the majority...as poll after poll and recent pivotal elections indicate...
so,work on something for those that lose/change jobs and the preexisting condition issues...work on closing the border(as it`s obvious that in certain parts of the country,illegal immigration is putting a huge economic strain on our healthcare system)...
and if some sort of single payer system is implemented,it must be truly single payer....that means that federal/city/state/union employees and governmental officials all get the same insurance without any exemptions....
lets see how that goes over in d.c.... a totally even playing field...what`s good for the goose is good for the gander...let`s see if the deal makers want to share in the misery of a plan that`s o.k. for the peons(but they want no part of for themselves)...
that`s all i`m saying on it......
over 80% are satisfied with their insurance/healthcare.....scrapping the entire system in favor of an incremental govenrment takeover that puts private insurers out of business and aims toward single payer just isn`t acceptable to many of us....the majority...as poll after poll and recent pivotal elections indicate...
so,work on something for those that lose/change jobs and the preexisting condition issues...work on closing the border(as it`s obvious that in certain parts of the country,illegal immigration is putting a huge economic strain on our healthcare system)...
and if some sort of single payer system is implemented,it must be truly single payer....that means that federal/city/state/union employees and governmental officials all get the same insurance without any exemptions....
lets see how that goes over in d.c.... a totally even playing field...what`s good for the goose is good for the gander...let`s see if the deal makers want to share in the misery of a plan that`s o.k. for the peons(but they want no part of for themselves)...
that`s all i`m saying on it......
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Definitely agree with your post GW....Especially the part with everybody having it if it is a single payer....
I'll let you try to figure out the real reasons why it lost 3.8 (not 600, retard) billion first before I cure you of your ignorance.
Hint:
It's been all over the news lately.
Potential reason you may not have the brains to find it:
It wasn't in picture form.
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yeh I just threw the 600 billion out there
so the PO only lost 3.8 billion ? wow . How do they stay in business ?
The internet paying bills and emails have hurt the PO. But their ungodly waste is what has them down and kicking. Everytime I go into a PO there are two people out front and a line of 20 people waiting for service. Bring some of them people out back with their thumb up their asses and teach them how to sell stamps. Is that so fawking hard ?
PO too used to gravy train too many years. Dont know how to run a company without losing gabillions.
the PO is a customer service nightmare.
I talked to a guy that worked for the PO one time and he said he could do his entire route in half a day. I asked him then what do you do ? He said I go home and sleep until its time to get off. :SIB
Listen I am from Vermont originally , so I know you are a fawking hillbilly
Not sure that came out right
A Mason City postal worker is accused of stealing gift cards being mailed to residents there.
State records indicate Julie A. Salisbury was working as a clerk at the Mason City Post Office late last year when officials from Victoria's Secret complained that one person had redeemed an unusually large number of gift cards the chain had mailed to Mason City residents.
One of Salisbury's co-workers reported seeing several Victoria's Secret cards in Salisbury's purse. That report was later confirmed, but Salisbury told her superiors she didn't know how the cards got there.:142smilie
The Postal Service's inspector general subsequently conducted a sting in which Salisbury had access to J.C. Penney gift cards that were being processed by the Mason City Post Office. State records show she subsequently redeemed three of the gift cards and admitted taking them.
The U.S. Postal Service attempted to fire Salisbury in December, but the postal workers' union appealed the decision and the matter is now scheduled for arbitration. :SIB
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They cant even fire people that are caught red handed stealing.
Geeez Louise
wtf
State records indicate Julie A. Salisbury was working as a clerk at the Mason City Post Office late last year when officials from Victoria's Secret complained that one person had redeemed an unusually large number of gift cards the chain had mailed to Mason City residents.
One of Salisbury's co-workers reported seeing several Victoria's Secret cards in Salisbury's purse. That report was later confirmed, but Salisbury told her superiors she didn't know how the cards got there.:142smilie
The Postal Service's inspector general subsequently conducted a sting in which Salisbury had access to J.C. Penney gift cards that were being processed by the Mason City Post Office. State records show she subsequently redeemed three of the gift cards and admitted taking them.
The U.S. Postal Service attempted to fire Salisbury in December, but the postal workers' union appealed the decision and the matter is now scheduled for arbitration. :SIB
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They cant even fire people that are caught red handed stealing.
Geeez Louise
wtf
Postal Service sticks employees in a closet?and pays them! "Standby time" is not just for customers anymore By Alex Salta Sep 11 2009,
R.B. Boyer
Not the only idle ones
Employees of the U.S. Postal Service, an agency facing a $7 billion deficit this year, average a whopping 45,000 hours of idle time every week?at an annual cost of about $50 million. :SIB
The reason for this sudden influx of downtime? That would be a combination of a 12.6% drop in mail volume over the past year, and a collective bargaining agreement that prohibits postal workers from being laid off or reassigned. :shrug:
"Standby time," as it is commonly known, is a practice that allows the USPS to keep employees on the clock and fulfill their contractual obligations. "Volume has dropped, we don't get the same mail receipts we used to get, and our overtime is already pretty much nil," Edward Jackson, a Washington, D.C. mail plant supervisor told the Federal Times. "But we still have to keep [employees] in a pay status. So we put them in standby rooms." :142smilie
Now you're probably wondering what a "standby room" is exactly. The truth is that it can be anything from an empty conference room to a 12-by-8 foot storage closet used as an area to contain employees who are on standby. "It's just a small empty room... It's awful," one employee said. "Most of us bring books, word puzzles. Sometimes we just sleep."
The standby practice has most directly affected the 220,000 members of the American Postal Workers Union, a union made up mainly of clerks and maintenance workers at post offices and processing centers, whose contract with the USPS forbids employees with more than six years experience to be laid off. The same contract also contains a clause guaranteeing "eight hours' pay for eight hours' work."
The USPS is left in the position of having too many workers for too little an amount of mail, and nothing to do with them except put them off to the side. Employees on standby are still technically available to work while on the clock, but days can sometimes go by before their assistance is needed, the story said.
It isn't exactly like the standby employees are thrilled about this arrangement either; this is not a classic case of "lazy government workers" slacking off on the job. "They just instruct employees to report to these holding areas," APWU President William Burrus tells the Times. "The Employees resent it. They can't work, they can't read, they just sit there."
Employees are forbidden to engage in any activity that they wouldn't do while performing normal work, this includes everything from listening to music to reading a book. "We want to make sure they uphold the rules and regulations of the Postal Service," Edward Jackson explained to the Times.
:142smilie
Knowing that many employees resent being put on standby, some supervisors have taken the process as an opportunity to punish employees. Bob Patterson, an APWU official from Oregon, told the Times of a case of a USPS being put on standby in a 12-by-8 storage closet as punishment for complaining about working conditions. "There was productive work she could be performing," Patterson contended.
While the USPS claims that it is being forced to implement standby time by burdensome union contracts (again, it must be noted that these are contract terms the USPS management agreed to), some employees are beginning to suspect that management is trying to get them to resign in protest rather then continue to work under these conditions. "I think they're trying to prove that they don't need people in the stations," Florida APWU representative Sam Wood told the Times. "Management says, ?We can do without these employees.'"
Wood went on to claim that one Florida mail processing plant told its employees that 10% of their workforce (58 workers) would be placed on standby until they could be reassigned to another location. Meanwhile, the reassignment process can take up to several months.
While the USPS and the APWU try to sort through this situation no one has seemed to have asked the public what they think of the dilemma. The USPS?agency of the aforementioned $7 billion deficit and the nationwide hiring freeze?is apparently operating under the assumption that their decisions are made in a vacuum. In reality they are operating under a $78 billion publicly funded budget. Spending $50 million a year so employees who are willing and able to work can sit in a closet and stare at a wall is a little bit of a problem.
Time will only tell if the postal service and the APWU will get their acts together, but at this point they're looking less reliable than the pony express
.................................................................
Dont mean to disrupt DJV health thread, but the PO is a big part of it when they arent paying their fair share.
Stop PO service on Saturdays :142smilie
Here is a novel idea - Put the fawkers in the stand by closets out front selling stamps .
Doogy fawking duh
R.B. Boyer
Not the only idle ones
Employees of the U.S. Postal Service, an agency facing a $7 billion deficit this year, average a whopping 45,000 hours of idle time every week?at an annual cost of about $50 million. :SIB
The reason for this sudden influx of downtime? That would be a combination of a 12.6% drop in mail volume over the past year, and a collective bargaining agreement that prohibits postal workers from being laid off or reassigned. :shrug:
"Standby time," as it is commonly known, is a practice that allows the USPS to keep employees on the clock and fulfill their contractual obligations. "Volume has dropped, we don't get the same mail receipts we used to get, and our overtime is already pretty much nil," Edward Jackson, a Washington, D.C. mail plant supervisor told the Federal Times. "But we still have to keep [employees] in a pay status. So we put them in standby rooms." :142smilie
Now you're probably wondering what a "standby room" is exactly. The truth is that it can be anything from an empty conference room to a 12-by-8 foot storage closet used as an area to contain employees who are on standby. "It's just a small empty room... It's awful," one employee said. "Most of us bring books, word puzzles. Sometimes we just sleep."
The standby practice has most directly affected the 220,000 members of the American Postal Workers Union, a union made up mainly of clerks and maintenance workers at post offices and processing centers, whose contract with the USPS forbids employees with more than six years experience to be laid off. The same contract also contains a clause guaranteeing "eight hours' pay for eight hours' work."
The USPS is left in the position of having too many workers for too little an amount of mail, and nothing to do with them except put them off to the side. Employees on standby are still technically available to work while on the clock, but days can sometimes go by before their assistance is needed, the story said.
It isn't exactly like the standby employees are thrilled about this arrangement either; this is not a classic case of "lazy government workers" slacking off on the job. "They just instruct employees to report to these holding areas," APWU President William Burrus tells the Times. "The Employees resent it. They can't work, they can't read, they just sit there."
Employees are forbidden to engage in any activity that they wouldn't do while performing normal work, this includes everything from listening to music to reading a book. "We want to make sure they uphold the rules and regulations of the Postal Service," Edward Jackson explained to the Times.
:142smilie
Knowing that many employees resent being put on standby, some supervisors have taken the process as an opportunity to punish employees. Bob Patterson, an APWU official from Oregon, told the Times of a case of a USPS being put on standby in a 12-by-8 storage closet as punishment for complaining about working conditions. "There was productive work she could be performing," Patterson contended.
While the USPS claims that it is being forced to implement standby time by burdensome union contracts (again, it must be noted that these are contract terms the USPS management agreed to), some employees are beginning to suspect that management is trying to get them to resign in protest rather then continue to work under these conditions. "I think they're trying to prove that they don't need people in the stations," Florida APWU representative Sam Wood told the Times. "Management says, ?We can do without these employees.'"
Wood went on to claim that one Florida mail processing plant told its employees that 10% of their workforce (58 workers) would be placed on standby until they could be reassigned to another location. Meanwhile, the reassignment process can take up to several months.
While the USPS and the APWU try to sort through this situation no one has seemed to have asked the public what they think of the dilemma. The USPS?agency of the aforementioned $7 billion deficit and the nationwide hiring freeze?is apparently operating under the assumption that their decisions are made in a vacuum. In reality they are operating under a $78 billion publicly funded budget. Spending $50 million a year so employees who are willing and able to work can sit in a closet and stare at a wall is a little bit of a problem.
Time will only tell if the postal service and the APWU will get their acts together, but at this point they're looking less reliable than the pony express
.................................................................
Dont mean to disrupt DJV health thread, but the PO is a big part of it when they arent paying their fair share.
Stop PO service on Saturdays :142smilie
Here is a novel idea - Put the fawkers in the stand by closets out front selling stamps .
Doogy fawking duh
Yes Sir Weisy
I think everyone agrees and welcomes any reform on cutting cost of healthcare--
The problem lies is some can't see the diff between reform and expansion of healthcare.
reform--If anyone can point to measures guaranteed to cut cost--lets hear em.
expansion-on flip side if anyone needs info on intent to add millions more to gov rolls /tax payers back-- I'll be happy to provide details.
Print SHARE THIS No comments - + September 9, 2009 11:22 PM EDT by John Stossel
The Post Office's "Standby Rooms"
The union representing postal supervisors was upset by President Obama?s crack last month that compared the Post Office to companies like FedEx and UPS: ?It's the post office that's always having problems.?
The union?s president complained that Obama ?chose the Postal Service as a scapegoat and an example of inefficiency.?
How can they deny it? The Federal Times reports that:
The U.S. Postal Service, struggling with a massive deficit caused by plummeting mail volume, spends more than a million dollars each week to pay thousands of employees to sit in empty rooms and do nothing...
(T)hey sit ? some for a few hours, others for entire shifts. Postal union officials estimate some 15,000 employees have spent time on standby this year. They spend their days holed up in rooms ? conference rooms, break rooms, occasionally 12-foot-by-8-foot storage closets ? that the Postal Service dubs ?resource rooms.? Postal employees use more colorful names, like ?holding pens? and ?blue rooms.?
?It?s just a small, empty room. ? It?s awful,? said one mail processing clerk who has spent four weeks on standby time this summer. ?Most of us bring books, word puzzles. Sometimes we just sleep.?
Wow. It could be a Freakonomics chapter: ?How is a postal worker like a NYC school teacher??
Normally, when a company has more employees than work , employees are laid off. But the Post Office, like the NYC school system, is a union shop.
(T)he American Postal Workers Union (APWU)... represents roughly 220,000 full-time postal employees?
The Postal Service?s collective bargaining agreement with APWU includes a no-layoff clause for employees with more than six years on the job.
Some idle workers were asked to use their down time to improve their job skills.
One mail handler in Pennsylvania said a supervisor used to force employees on standby time to read postal manuals.
?The local union shop filed a grievance against the Postal Service,? said the employee? ?We?re on standby time, not training time. ... You can?t make people read training materials on standby time.? :142smilie
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If we could clean up the PO of its waste of gabillions we could pay for health insurance for every man woman and child in America.
Then we got to get to medicare fraud.
shit pisses me off
The Post Office's "Standby Rooms"
The union representing postal supervisors was upset by President Obama?s crack last month that compared the Post Office to companies like FedEx and UPS: ?It's the post office that's always having problems.?
The union?s president complained that Obama ?chose the Postal Service as a scapegoat and an example of inefficiency.?
How can they deny it? The Federal Times reports that:
The U.S. Postal Service, struggling with a massive deficit caused by plummeting mail volume, spends more than a million dollars each week to pay thousands of employees to sit in empty rooms and do nothing...
(T)hey sit ? some for a few hours, others for entire shifts. Postal union officials estimate some 15,000 employees have spent time on standby this year. They spend their days holed up in rooms ? conference rooms, break rooms, occasionally 12-foot-by-8-foot storage closets ? that the Postal Service dubs ?resource rooms.? Postal employees use more colorful names, like ?holding pens? and ?blue rooms.?
?It?s just a small, empty room. ? It?s awful,? said one mail processing clerk who has spent four weeks on standby time this summer. ?Most of us bring books, word puzzles. Sometimes we just sleep.?
Wow. It could be a Freakonomics chapter: ?How is a postal worker like a NYC school teacher??
Normally, when a company has more employees than work , employees are laid off. But the Post Office, like the NYC school system, is a union shop.
(T)he American Postal Workers Union (APWU)... represents roughly 220,000 full-time postal employees?
The Postal Service?s collective bargaining agreement with APWU includes a no-layoff clause for employees with more than six years on the job.
Some idle workers were asked to use their down time to improve their job skills.
One mail handler in Pennsylvania said a supervisor used to force employees on standby time to read postal manuals.
?The local union shop filed a grievance against the Postal Service,? said the employee? ?We?re on standby time, not training time. ... You can?t make people read training materials on standby time.? :142smilie
.................................................................
If we could clean up the PO of its waste of gabillions we could pay for health insurance for every man woman and child in America.
Then we got to get to medicare fraud.
shit pisses me off
..............................................
cut out waste, fraud , and doctor crooks in the system. Search them out and put them in jail.
it seems so simple
I know its a difficult concept for you black gumby
Coburn says 20 percent of every Medicare dollar goes to fraud
The senator said, "If you look at Medicare and Medicaid, both vital programs today, they're highly inefficient. People claim that they're efficient. Medicare has at least $80 billion worth of fraud a year. That's a full 20 percent of every dollar that's spent on Medicare goes to fraud. And Medicaid is not much better. We don't actually have the numbers because half the states aren't reporting their Medicaid fraud. So when you have programs that are designed to be defrauded, even though they're well-intended and they are helping people, we ought to think about how do we get better value for that money and less money going out the door. "
In this item, we'll focus on Coburn's estimate that there is $80 billion in Medicare fraud annually.
After speaking to health care experts and searching on the Internet, we found that while Medicare fraud is a notable concern, statistics offered to document the scale of the problem are slippery at best. On May 6, 2009, Daniel Levinson, the inspector general of the Department of Health and Human Services, testified before the Senate Special Committee on Aging that "it is not possible to measure precisely the extent of fraud in Medicare and Medicaid." :SIB
As a result, estimates of fraud in the system vary ? widely.
The number Levinson offered lawmakers is one from the National Health Care Anti-Fraud Association. Levinson said that the NHCAA ? whose members include private insurance companies and government agencies ? estimated that "at least 3 percent ? or more than $60 billion each year ? is lost to fraud." But as Levinson was careful to note, the $60 billion figure covers fraud in all U.S. health care expenditures ? not just in Medicare, which would mean that Coburn is way off in his estimate.
But before drawing any conclusions, we turned to the NHCAA for more background on that figure, which is, to be exact, $68 billion.
Louis Saccoccio, the NHCAA's executive director, told PolitiFact that the 3 percent estimate is calculated from the experiences of the private insurers who belong to his group. But he emphasized that it is indeed an estimate, and a conservative one at that. "No one has a hard number," he said, "because you can't go out with a survey and ask, 'How much are you robbing from Medicare?'"
Another prominent figure in the field, Malcolm Sparrow, argues that estimates in the range of 3 percent are low ? "ridiculously low," he put it in an interview. Sparrow, a onetime fraud investigator and detective chief inspector with the British police service, is now a professor at Harvard's Kennedy School of Government.
Sparrow agrees with Saccoccio that no one has put together an accurate accounting of Medicare fraud. But he argues that the kind of errors detected by current control systems are primarily technical glitches ? not the products of criminal minds setting out to defraud the system. And given that Medicare offers a large pot of money, a high degree of automation in its claims-paying process and limited auditing capabilities, he argues, the program is a godsend for dedicated con artists.
"Criminals, who are intent on stealing as much as they can and as fast as possible, and who are prepared to fabricate diagnoses, treatments, even entire medical episodes, have a relatively easy time breaking through all the industry's defenses," Sparrow testified before the Senate Judiciary Subcommittee on Crime and Drugs on May 20, 2009. "The criminals' advantage is that they are willing to lie. And provided they learn to submit their bills correctly, they remain free to lie. The rule for criminals is simple: If you want to steal from Medicare, or Medicaid, or any other health care insurance program, learn to bill your lies correctly. Then, for the most part, your claims will be paid in full and on time, without a hiccup, by a computer, and with no human involvement at all."
His evidence is anecdotal but suggestive. In a recent academic paper, Sparrow noted that then-FBI Director Louis Freeh testified in 1995 that cocaine traffickers in Florida and California were switching from drug dealing to health care fraud because they discovered that health care fraud was safer, easier and more lucrative than the drug trade, and that it carried a smaller risk of detection. In 1997, Sparrow added, the New York Times reported that organized crime families in New York City and New Jersey were abandoning extortion and bid-rigging in favor of new criminal enterprises such as health insurance fraud. Usually, he writes, major frauds are uncovered by whistleblowers rather than audit systems. One example is the case of Columbia HCA, a major hospital chain that in 2003 agreed to a $1.7 billion settlement with the Justice Department after 10 years of investigations initiated by whistleblower allegations.
Sparrow also points to suits under the federal False Claims Act as evidence of a major fraud problem in the health care sector. The False Claims Act allows citizens to allege the existence of defrauding the government and then reap a share of the government's savings once the improprieties are rooted out. False Claims Act suits against HHS now account for a large majority of all such suits filed annually. "There is apparently no other area of federal spending so vulnerable to fraud, and so deeply infected," Sparrow writes.
Sparrow testified that because HHS audit procedures do not dig very deep, "we now have no reliable indications of the overall fraud loss rates for the Medicare program." (A spokeswoman for the HHS Inspector General's Office declined to comment on Sparrow's analysis.)
Now, back to Coburn's assertion. When we called his office, his staff told us that his source for the comment was an article in the National Review , a conservative magazine. The July 15, 2009, article said of Sparrow, "He thinks that as much as 20 percent of the federal health care budget is consumed by fraud, which would be $85 billion a year for Medicare." That's pretty close to what Coburn said on Van Susteren's show.
But is the senator right? It depends on whether you trust NHCAA or Sparrow.
Total Medicare outlays were $431 billion in 2007, or 19 percent of total national health care expenditures. If one assumes that fraud is equally prevalent in Medicare and other types of health care, that would make the Medicare share of the NHCAA's $68 billion fraud estimate $13 billion. And $13 billion in fraud divided by $431 billion in total Medicare outlays would be 3 percent of total Medicare expenditures ? a far cry from Coburn's 20 percent. (A rate of 20 percent is "possible, but I don't think it's very plausible," Saccoccio said.)
Skeptical that Medicare is only being defrauded at rates equal to the private sector? Let's triple that number to $39 billion in fraud. If you do that, it still comes out to 9 percent ? less than half of what Coburn asserted it was.
In the meantime, Coburn's dollar figure ? $80 billion in fraud ? would be no more accurate if the NHCAA is right. The group says there's $68 billion in fraud in all health care expenditures ? but Coburn's figure for Medicare alone is bigger than that.
However, by Sparrow's analysis, Coburn could indeed be in the ballpark. In an interview, Sparrow himself said the Coburn estimate is "perfectly plausible." He added that Coburn "doesn't know any more than you or I do."
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too many crooks to really stop this fraud
we would be surprised at who in the US benifits
from this stealing. It goes right to the core of taking health care away from deserving Americans.
The senator said, "If you look at Medicare and Medicaid, both vital programs today, they're highly inefficient. People claim that they're efficient. Medicare has at least $80 billion worth of fraud a year. That's a full 20 percent of every dollar that's spent on Medicare goes to fraud. And Medicaid is not much better. We don't actually have the numbers because half the states aren't reporting their Medicaid fraud. So when you have programs that are designed to be defrauded, even though they're well-intended and they are helping people, we ought to think about how do we get better value for that money and less money going out the door. "
In this item, we'll focus on Coburn's estimate that there is $80 billion in Medicare fraud annually.
After speaking to health care experts and searching on the Internet, we found that while Medicare fraud is a notable concern, statistics offered to document the scale of the problem are slippery at best. On May 6, 2009, Daniel Levinson, the inspector general of the Department of Health and Human Services, testified before the Senate Special Committee on Aging that "it is not possible to measure precisely the extent of fraud in Medicare and Medicaid." :SIB
As a result, estimates of fraud in the system vary ? widely.
The number Levinson offered lawmakers is one from the National Health Care Anti-Fraud Association. Levinson said that the NHCAA ? whose members include private insurance companies and government agencies ? estimated that "at least 3 percent ? or more than $60 billion each year ? is lost to fraud." But as Levinson was careful to note, the $60 billion figure covers fraud in all U.S. health care expenditures ? not just in Medicare, which would mean that Coburn is way off in his estimate.
But before drawing any conclusions, we turned to the NHCAA for more background on that figure, which is, to be exact, $68 billion.
Louis Saccoccio, the NHCAA's executive director, told PolitiFact that the 3 percent estimate is calculated from the experiences of the private insurers who belong to his group. But he emphasized that it is indeed an estimate, and a conservative one at that. "No one has a hard number," he said, "because you can't go out with a survey and ask, 'How much are you robbing from Medicare?'"
Another prominent figure in the field, Malcolm Sparrow, argues that estimates in the range of 3 percent are low ? "ridiculously low," he put it in an interview. Sparrow, a onetime fraud investigator and detective chief inspector with the British police service, is now a professor at Harvard's Kennedy School of Government.
Sparrow agrees with Saccoccio that no one has put together an accurate accounting of Medicare fraud. But he argues that the kind of errors detected by current control systems are primarily technical glitches ? not the products of criminal minds setting out to defraud the system. And given that Medicare offers a large pot of money, a high degree of automation in its claims-paying process and limited auditing capabilities, he argues, the program is a godsend for dedicated con artists.
"Criminals, who are intent on stealing as much as they can and as fast as possible, and who are prepared to fabricate diagnoses, treatments, even entire medical episodes, have a relatively easy time breaking through all the industry's defenses," Sparrow testified before the Senate Judiciary Subcommittee on Crime and Drugs on May 20, 2009. "The criminals' advantage is that they are willing to lie. And provided they learn to submit their bills correctly, they remain free to lie. The rule for criminals is simple: If you want to steal from Medicare, or Medicaid, or any other health care insurance program, learn to bill your lies correctly. Then, for the most part, your claims will be paid in full and on time, without a hiccup, by a computer, and with no human involvement at all."
His evidence is anecdotal but suggestive. In a recent academic paper, Sparrow noted that then-FBI Director Louis Freeh testified in 1995 that cocaine traffickers in Florida and California were switching from drug dealing to health care fraud because they discovered that health care fraud was safer, easier and more lucrative than the drug trade, and that it carried a smaller risk of detection. In 1997, Sparrow added, the New York Times reported that organized crime families in New York City and New Jersey were abandoning extortion and bid-rigging in favor of new criminal enterprises such as health insurance fraud. Usually, he writes, major frauds are uncovered by whistleblowers rather than audit systems. One example is the case of Columbia HCA, a major hospital chain that in 2003 agreed to a $1.7 billion settlement with the Justice Department after 10 years of investigations initiated by whistleblower allegations.
Sparrow also points to suits under the federal False Claims Act as evidence of a major fraud problem in the health care sector. The False Claims Act allows citizens to allege the existence of defrauding the government and then reap a share of the government's savings once the improprieties are rooted out. False Claims Act suits against HHS now account for a large majority of all such suits filed annually. "There is apparently no other area of federal spending so vulnerable to fraud, and so deeply infected," Sparrow writes.
Sparrow testified that because HHS audit procedures do not dig very deep, "we now have no reliable indications of the overall fraud loss rates for the Medicare program." (A spokeswoman for the HHS Inspector General's Office declined to comment on Sparrow's analysis.)
Now, back to Coburn's assertion. When we called his office, his staff told us that his source for the comment was an article in the National Review , a conservative magazine. The July 15, 2009, article said of Sparrow, "He thinks that as much as 20 percent of the federal health care budget is consumed by fraud, which would be $85 billion a year for Medicare." That's pretty close to what Coburn said on Van Susteren's show.
But is the senator right? It depends on whether you trust NHCAA or Sparrow.
Total Medicare outlays were $431 billion in 2007, or 19 percent of total national health care expenditures. If one assumes that fraud is equally prevalent in Medicare and other types of health care, that would make the Medicare share of the NHCAA's $68 billion fraud estimate $13 billion. And $13 billion in fraud divided by $431 billion in total Medicare outlays would be 3 percent of total Medicare expenditures ? a far cry from Coburn's 20 percent. (A rate of 20 percent is "possible, but I don't think it's very plausible," Saccoccio said.)
Skeptical that Medicare is only being defrauded at rates equal to the private sector? Let's triple that number to $39 billion in fraud. If you do that, it still comes out to 9 percent ? less than half of what Coburn asserted it was.
In the meantime, Coburn's dollar figure ? $80 billion in fraud ? would be no more accurate if the NHCAA is right. The group says there's $68 billion in fraud in all health care expenditures ? but Coburn's figure for Medicare alone is bigger than that.
However, by Sparrow's analysis, Coburn could indeed be in the ballpark. In an interview, Sparrow himself said the Coburn estimate is "perfectly plausible." He added that Coburn "doesn't know any more than you or I do."
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too many crooks to really stop this fraud
we would be surprised at who in the US benifits
from this stealing. It goes right to the core of taking health care away from deserving Americans.
