It is well known that most nursing home residents are participants in the Medicaid and Medicare programs. Medicare is the health insurance program for seniors while Medicaid provides support for those with low-incomes. Medicare generally only pays for short, rehabilitative nursing home stays. Residents who need to move into a nursing home for a longer period of time usually need Medicaid support to pay for that care.
All of this means that the constant policymaking confusion and budget concerns about these programs understandably worry local seniors. So many actual lives hang in the balance with support for these programs, and so everything possible needs to be done to preserve the stability of the institutions. Undoubtedly this might involve large-scale restructuring of tax rates, reimbursement details, and similar matters. However, another facet is simply working to cut down on wasteful medical spending and fraud.
Fighting Medicare Fraud
In an attempt to ensure no spending is wasted, since his election in 2008 President Obama has been particularly aggressive about rooting out wasteful Medicaid billing. That includes pursuing those who abuse the system in order to maximize their own profits. Billions of dollars are spent each year on unnecessary, inefficient, and fraudulent services.
Crain’s Chicago Business discussed the stepped up efforts to tackle this problem in our city. According to the story, the number of criminal prosecutions of medical professionals in Chicago has gone up steadily in recent years. In the past there were only a handful of such prosecutions total, but there have been twenty in the last year alone. This is not a sign of a growing problem but is instead indicative of stepped up enforcement efforts to tackle a problem that has been raging for some time.
The stories coming out of Chicago alone are shocking. For example, there are criminal cases for fraud in our area related to billing for more than 24 hours of service in a single day by a single person. At other times home health aides are billing for care provided to individuals who were dead at the time that the services were supposedly performed. At other times certain medical industry workers bill for use of expensive equipment when in reality the patient actually only received substandard equipment.
The root motivation in all cases is the same: get more money from public coffers by doing less for actual patients. Not only does this problem affect the bottom-line budgets of these fragile programs, but it also often leads to serious harm to patients. It is imperative that seniors using Medicare actually recieve the quality of equipment and full extent of services that they need. Medical professionals should never be able to get away with providing less and billing more.
Fortunately, the increased effort to root out Medicare fraud seems to be working. For example, nationwide statistics indicate that since 2009 the U.S. Attorney General’s office has been able to re-coup over $11 billion in funds. Those stats shouldn’t be underestimated. Thousands and thousands of seniors might now receive care thanks to those funds which otherwise would be a significant dent on the program budget. All serious efforts seeking to preserve Medicare and Medicaid for the long-haul must take these fraud issues into account.
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