As a user of Medicare, being unfortunately retired when I should be running a major media company (har dee har har), I have a few years of experience using the program’s services. Now, the first thing I must observe is best stated by using a sentence I learned while serving in the U.S. Navy: “Hurry up and wait.” By this, I mean appointments are not easy to come by.
For the Medicare system to survive, there must be some measure of rationing, and that measure reveals itself in how many people are in line in front of you for much-needed services. Hurry up and wait.
That, however, is not the subject of this particular post. What I want to address is the issue of Medicare/Medicaid fraud, which the DOGE (Department of Government Efficiency) team has been saying they’ve uncovered by the boatload.
Now I have no doubt that, probably more so with Medicaid than with Medicare, there are enrollees who simply don’t qualify but have found a way to game the system. However, from my vantage point, I think provider fraud and abuse are probably more prevalent, and more costly dollar-wise, than user abuse.
What’s to prevent a provider from billing either program for services not rendered? My guess is there may be hoops to jump through to do so, but it’s altogether possible.
A few months ago when I developed pain in my knees, my general practitioner referred me to a physical therapy group. No matter how many times I called, they never answered and never returned the endless voicemails I left for an appointment. I finally drove over to make an appointment. (They ignored me when I asked why they never answered their phone or returned voicemails.)
I kept wondering why they would never answer their phone or return calls. I realized after a few visits for treatment, however, that they simply bill Medicare for services once they get a referral. In my case, the referral was for five visits.
I ended up going only three times becuase a) the therapy only made my pain worse and b) I developed a hernia, which meant I had to put exercise on hold. I’m sure they billed for five visits, probably before I ever even showed up to ask for an appointment.
Anyway, my guess is that there are many such providers who game the system, and if these providers observe the “rules” of submitting a claim to be repaid, they probably do get compensation for doing nothing.
If you multiply my one small example across the medical landscape of the entire nation, you can get an idea of the rampancy of fraud, at least potentially but no doubt in reality,