http://www.cato-at-liberty.org/health-care-executive’s-medicare-fraud-scheme-included-lobbying-washington
‘Health-Care Executive’s Medicare Fraud Scheme Included Lobbying Washington’
Posted by Michael F. Cannon
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Miami health-care executive Larry Duran orchestrated one of the largest Medicare frauds in U.S. history, submitting more than $205 million in phony claims and landing a record-breaking 50-year prison sentence for his crimes.
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The basic scheme, records show, worked like this: Duran and Valera paid up to $400,000 a month in kickbacks to assisted living centers, halfway homes and others to procure a steady stream of patients for their clinics, which claimed to be providing group mental health treatment. Doctors frequently faked records or signed off on charts without seeing any patients.
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The basic theorem is this: market actors have greater incentives to prevent fraud, because it’s their own money on the line. Politicians are spending other people’s money, so their incentive to prevent fraud is far less. Therefore, fraud will always be higher in government programs than in similar market endeavors.
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I remember back to my first encounter with “health, health insurance, and health costs”, a least the first one that I remember, was my appendix operation.
I got great care and my Mom, rest her soul, got the bill. I remember it was just a little less than $500!
A huge amount in those days.
She took some from savings, some from family, and some from her “stash”. (Depression era people ALWAYS had money stuffed somewhere in case the banks closed again.)
That bill was on the refrigerator and everyone looked at it for errors.
(Visitors tried to remember if I got the stuff that was on the bill.)
She paid the bill and assembled all the bills (i.e., hospital, doctor, drugs) and sent it to Blue Cross Blue Shield Insurance.
A couple of months later, she received a check and an explanation. On the refrigerator again.
It was about 80% of what she paid.
There was a lot of conversation and some correspondence about the whole matter.
Eventually, she got another check for a little more.
Fraud?
Not likely with that level of scrutiny!
So, I agree that Gooferment program equals fraud.
Argh!
Clearly, there has to be a fundamental restructuring of these programs so that the beneficiary pays something. Even a tiny per centage will prevent fraud.
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Posted by reinkefj 
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