AUTOMATIC ELECTRONIC PAYMENT OF MEDICARE CLAIMS (YOUR TAX MONEY) MAKES FRAUD TOO EASY

Last year, a jury convicted a pastor and his wife of fraudulently claiming $14.2 million from Medicare. They recruited perishioners to run fake durable medical equipment companies and spen the moneys on cars and other luxuries. Also last year, 52 members of an Armenian American organized crime ring were arrested anc charged with $163 million in fraudulent Medicare billing. Each month reports come out about ridiculous Medicare and Medicad claims paid without oversight. The problem is not the healthcare policy but rather the fact that Uncle Sam has chosen to to pay Medicare and Mediaid claims electronically and automatically in response to electronic claims received from an army of providers. The crooks only have to learn the rules and then they submit thousands of claims electronically and if they make a mistake, they will get a nice computer generated message explaining their mistake. Most claims are dealt with solely by computers using rule-based systems with no human involvement at all. The claims are simply paid on trust with little or no verification at all. Organized crime groups, prisoners and others troll government web sites seeking programs which are vulnerable because of the way they pay by computer. In addition, national companies providing health care services know that only a tiny percentage of payments will be audited so they run over the line of patient medical needs (required by the Social Security Act of 1965) and bill Medicare for excessive treatment to the tune of hundreds of millions of dollars each year. See LICENSE TO STEAL: HOW FRAUD BLEEDS AMERICA’S HEALTH CARE SYSTEM by Malcolm Sparrow.