 |
Fraud, Fraud, and More Fraud |
 |
Looking over today’s daily health care news clips, it’s easy to see a focus on fraud in the media. Here are two big medical fraud stories that have broken today, with many more in the past few weeks:
3 Hospitals Accused of Using Homeless for Fraud - Los Angeles Times
On a Sunday afternoon two years ago, five homeless people being dropped off on Los Angeles’ skid row by an ambulance caught the attention of police officers.
Ohio Exec Gets 15 Years in Prison for $1.9B Fraud - Associated Press
A former executive at a health care finance company was sentenced Wednesday to 15 years in prison for his role in a $1.9 billion corporate fraud case that federal prosecutors compared to the Enron or WorldCom scandals.
There is no question fraud in the health insurance industry is an issue. With so many folks out to make a buck in a multi-billion dollar industry, someone is going to break the law. It’s unfortunate, and this kind of stuff should be prosecuted with extreme prejudice.
But simply cutting down on fraud isn’t going to solve our health care crisis.
Cutting fraud at the edges of this multi-billion dollar industry isn’t going to make our spiraling health care costs go away. It isn’t going to make the insurance industry suddenly stop denying coverage at every turn that the American people have paid for. And it won’t take the place of a public health plan that everyone can opt-in to. Put very simply, cutting down on fraud and waste does nothing to address the fundamental problems inherent in our health care system: Uneven risk pools, no sensible check on cost, and profits before people.
Add that to the statistic that as of today, a full 82% of Americans think our health care system needs a major overhaul. Now, 82% of Americans hardly agree on anything, but apparently, our private health care system is failing so badly that more than 8 out of 10 agree we need change. That’s an amazing consensus, and it creates a powerful motivation for our politicians in Washington to make that change happen.
To be clear, simply cutting down on “waste and abuse” or “fraud” isn’t a major overhaul in anyone’s book. We need more.
That’s great news…I hadn’t seen the 82% figure.
I’m going to push back a little on whether the “buy-in” option is feasible though–and whether it constitutes a “major overhaul.” It seems likely that insurance companies would use denial, delay, bureaucracy, lobbying, influence, and marketing to push their expensive, high-risk patients into the public Medicare option. Then we have all the elderly and sick patients in one risk pool…while insurers laugh all the way to the bank because they have the young and healthy patients who don’t require much “medical loss” (i.e., paying claims).
A better option would be John Conyers’ HR 676, which has the support of over 425 labor organizations, 92 members of Congress, and the grassroots healthcare movement.
Keep up the advocacy!
Shum Preston