Hmm. Have you ever considered why your Explanation of Benefits (the billing summary Blue Cross, Blue Shield and others mail out) routinely names sums no one was paid?

Then... I got an MRI. In the bill was two seperate items for "eye examination", for $50 each. The "exam" consisted of the tech asking if I'd ever been operated on to remove an object from an eye.

The BCBS custodian defended the charge!

This isn't Medicare, but it's the direct result of "insurance" making it "someone else's job" to see that costs correspond to results.

Obamacare, before passing any legislation changing health care as we know it, should first cut the waste, fraud, and abuse in Medicare and strive to insure that Medicare is always properly funded so that it never goes broke. THEN, and only then, should Obamacare be considered.

There you go again, Nick, trying to be sensible.

Don't you understand they Hope to Change America?

And how can we do that without increasing the opportunities for graft and corruption?

So just sit back, pop a cold one, and hand your wallet to the nice man with the sack.

This might sting a little.

Of course, Brian ( slaps forehead knocking sense into the brain ). What was I thinking?

Brian, you never, EVER fail to crack me up. I admit I'm starting to develop a "blog crush" if there's such a thing...

Thanks for the chuckle :-)

TOB, I've had a "blog crush" on Brian for quite some time; he never fails to amuse, or to make sense, most of the time. (I've seen him and Crid get into it, though, and it's not pretty.)

What's stunning to me is how often these atrocities are committed. (Medicare fraud, I mean, not the to-dos between Brian and Crid. Those I look forward to! o.O)

(I've seen him and Crid get into it, though, and it's not pretty.) Posted by: Flynne

Its fun to watch though

I actually sat in on a recruiting seminar for a company called IntegriGuard. They review and look for fraudulent medicare billing.

I was stunned when they revealed how much Medicare fraud there is.

I couldn't believe our government could be that grossly taken advantage of. Amazing!

South Florida... why am I not surprised. When I lived there, locals referred to it as "Fraud Lauderdale", and there was a reason why. Although back in the day, it was gold investment scams that were all the rage.

And yes, it does seem like doctors and particularly hospitals can charge any damn thing they want for anything, and no one questions it. I had a roundabout with a South Florida hospital that went on for over a year -- they had double-billed for a procedure. The insurance company caught it and refused to pay, but they didn't help me work it with the hospital either. I had bill collectors calling me, and I finally had to write them a check so my credit wouldn't be ruined, because there didn't seem to be any other avenue available (it was too large an amount to take to small claims). Months later, the hospital finally admitted their mistake, but it took me another two months to get it refunded.

This is a good example of the incompatibility of socialism and the American entrepreneurial culture. Socialism may work in Europe where the people tend to think of themselves as more united and having a shared history and culture. You can see overthere that system starting to fail for the Dutch, Germans and others as they witness newcomers and outsiders taking advantage of their social programs. Here in the U.S. the damage is compounded by the general spirit of industrialism shared by a majority of the people and large numbers of individuals that don't have any allegiance to the U.S. Constitution or rule of law. They come for a better life, which is very much what America is all about. And good for them, and you and me. But you can't have a bunch of people determined to give themselves a better life AND excessive government handouts.

It reminds me of a dysfunctional family situation where the parents encourage independence but end up neglecting their teenage kids a bit. If those parents keep some cash stored in a drawer somewhere where they don't keep track of every penny, I say don't be surprised if some of that cash goes missing. Stupid, stupid.

On a possible "bright side", I bet the stats on drug related violent crime show safer streets in South Florida than back when cocaine was King.

Sorry but I couldn't make it past 10 seconds in. Croft opening up with the tired line of "the most important problem facing America right now is Healthcare costs" my eyes glaze over. No you ninny, the biggest problem we face is an economy that is very very likely to implode, especially when the gov is trying to "stabilize" things like the housing market with an $8k bribe to buy a hugely overpriced house.

Anyway, another medicare fraud story isn't really new information though maybe helpful to get people to realize that fedgov healthcare isn't the answer.

Nick said: "Obamacare, before passing any legislation changing health care as we know it, should first cut the waste, fraud, and abuse in Medicare and strive to insure that Medicare is always properly funded so that it never goes broke. THEN, and only then, should Obamacare be considered."

I agree wholeheartedly! In the software consulting industry where I work, what we always do is implement a pilot project with a handful of users and then make great efforts, tweaks, etc. to absolutely ensure that everything is working properly and as perfectly as possible. ONLY then do we expand the use of the software to the great whole.

The government always seems to do this in reverse, by launching a poorly designed, poorly built system on the population as a whole.

NUTS!

"I've seen him and Crid get into it, though, and it's not pretty."

I'm a bigger fan of the Crid/Tressider matches. Any time you dawgs want to place odds ...

"... first cut the waste, fraud, and abuse in Medicare and strive to insure that Medicare is always properly funded so that it never goes broke ..."

Okay, you're on the right track. But even if you cut all the waste and fraud out, the system would still be broke. Because there simply isn't enough of other people's money to provide everyone with a million dollar death. The death business, like the housing business, is another example of the population in general trying to live beyond its means.

So you could say that Medicare shouldn't exist in the first place. No government program to go broke or be defrauded in the first place.

But then what do you do with all these broke-assed people who can't afford to spend the last year of their lives in the hospital? Give them some morphine cheap, try to make them more comfortable, and let them croak? That's just not something the manicured-lawn set feels comfortable with.

Well the fraud sucks. But in all honesty, the amount paid in claims, 500 billion. and the amount of fraud, 60 billion. OK, that's 12%. And for a government agency, that's really not that bad.

That is sarcastic. Sorta. The real waste is in the bureaucracy.

OK, health care is expensive. Everybody can't have it all for free (or more specifically, at the expense of those of us who do pay taxes).

I don't see why the government can't see that. We can't afford healthcare for everyone as a country. Shit, we can't afford what we already have.

Drop it, work on the economy, then address it later.

Exactly, sterling.

Sure, they could eliminate that $60 billion in fraud, if they replaced it with $60 billion in fraud detection, but we'd still have a vastly underfunded program. And if we funded it? I mean, truly funded it? (Not through borrowing.) We'd live in mud huts until we were old and sick, then move to nice hospitals in our old age.

What would happen if health care was privatized just like grocery stores? Where we could shop at competing stores for the best price, and the poorest among us could get some kind of voucher, akin to food stamps, to help pay for it? How might this work in the education sector, too, for that matter?

We will never know. That system existed once, but there are no people still alive who remember it. Health care problems will continue to plague people, because that's just the nature of being a mammal. Illiteracy will continue to plague people, because there are few people with learning disabilities and a lot of people with shitty parents. What are the rest of us supposed to do about it?

I don't think government (at least, FEDERAL government) programs are the way to solve these problems. But I'm afraid free-market solutions are going to be held to the "perfection" standard, which I don't think we can attain. So we will continue with solutions that are irreparably broken and proven failures, and, since they are run at the federal government level, borrowing will postpone the inevitable collapse of these systems, to all our detriment.

Just makes you wanna scream and throw things.... I almost wish we had the Chinese legal system.

And Pirate Jo, we adopt to the system.

I could make so much more money as an independent IT consultant, even in this shit economy. But the single parent thing makes travel difficult: I need stability and health insurance. I chose a job that pays little but has full benefits (medical/dental) at a university. I pay part of that insurance premium, but the university pays most. And the deductible and co-pays are high. But we are covered.

I could do a couple projects a year, and make three/four times my current salary. But I'd have to deal with insurance, so I chose a less difficult path (I have pre-existing blood pressure and kidney issues, though I am in extremely good health).

Health care has always been a lifestyle choice for me. And for the dumb, lazy, and rightfully unconcerned about health insurance, tough shit. I had to save $1000 to prepay for outpatient surgery last May, getting some calcium deposits cut from my elbow's. Sucks, ruined my summer budget. So why in the hell would I want to pay for some asshole that doesn't hold a job or pay 'insurance premiums/taxes'

Costa Rica is looking pretty good these days...

Hey, not to derail the topic - but this is sort of related. But have any of y'all ever looked into an accident-only insurance policy? An insurance representative says he can't offer it, yet I see things on-line, sporting premiums of $25/$35 a month. I wonder if they are scammers.

PJ - depends on the state you're in. They've just allowed non-comprehensive (i.e. HMO) policies in CT in the last year or three.

"Hey, not to derail the topic - but this is sort of related. But have any of y'all ever looked into an accident-only insurance policy? An insurance representative says he can't offer it, yet I see things on-line, sporting premiums of $25/$35 a month. I wonder if they are scammers."

Most people already have an "accident only" insurance policy. It is under the comprehensive part of their auto insurance. The most likely way to get seriously injured in this country is in an automobile accident. Hospital cost incurred through an auto acciden0t will be paid by the driver's insurance if the other driver was at fault and or by you UIM (uninsured underinsured motorist coverage) on your policy. You should make sure that your UIM is high enough to cover some serious hospitalization and it is really cheap insurance. So if you are paying an additional 25 bucks a month to cover slipping on the ice or falling in the shower that is pretty expensive coverage for what is usually going to be an extremely small subset of events. Isabel

I was thinking of a friend of mine, who recently fell while roller-blading and broke his wrist, to the tune of $7,000.

I looked into an individual health policy with Humana, and I could get the monthly premiums down to $72 per month, but the deductible would be a whopping $7,500. It seems crazy to pay even $72 a month, just for the privilege of paying all my medical costs out of pocket anyway - which I would, for that kind of deductible.

Sterling, have you considered working as a contractor, but through a "handler?" One of those IT firms? They pay well, and you can get insurance through them also. That's what I'm going to end up doing. Insurance will cost me around $100 a month, maybe $120, but without the giant deductible. The company doesn't pay for any of it, but I'm able to get a much better deal just because I can be on a group, rather than individual, policy.