No. of Recommendations: 1
All the single payer advocates on this board will memory-hole this as fast as they can. I have wondered how the French system reduces fraud.
Of course, the "big gummit" programs are not the only ones that are defrauded.
from the net sifter:
US private health insurers lose billions to fraud annually, with estimates varying widely, but figures often fall in the tens of billions to over $100 billion, with some sources suggesting it could reach $240 billion annually, though exact figures are elusive, with a significant portion of overall healthcare fraud (potentially over $300 billion total) impacting private plans. These losses are driven by provider overbilling, false claims, and patient fraud, ultimately increasing premiums for everyone.
Key Figures & Estimates:
General Healthcare Fraud: Estimates for total U.S. healthcare fraud (including Medicare/Medicaid) range from $100 billion to over $300 billion annually.
Private Health Insurance: One analysis suggests private insurers might lose around $240 billion annually if 20% of their spending is fraudulent.
The NC Department of Insurance cites estimates placing private health insurance fraud at $36.3 billion annually, part of a larger $105 billion total for public and private health insurance fraud.
Provider Fraud: A significant chunk involves providers billing for unrendered services or upcoding (billing for more complex services than provided)Fraud is a growth industry in Shinyland. Some of us remember when Tenet Healthcare's core business model was cheating Medicare.
Hospital Chain Will Pay over $513 Million for Defrauding the United States and Making Illegal Payments in Exchange for Patient Referrals; Two Subsidiaries Agree to Plead Guilty
A major U.S. hospital chain, Tenet Healthcare Corporation, and two of its Atlanta-area subsidiaries will pay over $513 million to resolve criminal charges and civil claims relating to a scheme to defraud the United States and to pay kickbacks in exchange for patient referrals. justice.gov - Hospital chain will pay over million defrauding united states and making illegal paymentsSEC Charges Tenet Healthcare Corporation and Four Former Senior Executives With Concealing Scheme to Meet Earnings Targets by Exploiting Medicare System
Washington, D.C., April 2, 2007 — The Securities and Exchange Commission today filed civil fraud charges in federal district court against Tenet Healthcare Corporation and its former chief financial officer and co-president, its former chief operating officer and co-president, its former general counsel and chief compliance officer, and its former chief accounting officer for failing to disclose to investors that Tenet's strong earnings growth from 1999 to 2002 was driven largely by its exploitation of a loophole in the Medicare reimbursement system. Once Tenet finally revealed its scheme to the investing public and admitted that its strategy was not sustainable, the market value of Tenet's stock plunged by over $11 billion.U.S. Securities and Exchange Commission: FilingPrivate insurance companies are often bilked as well, in spite of the obstacles they throw up, impeding legitimate claims. They don't want to admit how much they lose, because it would upset shareholders at their breakfast.
Steve
