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August 7th, 2009
07:37 AM ET

Health care reform: forgetting fraud

Theresa Langlois says when she read her insurance statement she knew her podiatrist had been cheating Blue Cross Blue Shield of Michigan.
Theresa Langlois says when she read her insurance statement she knew her podiatrist had been cheating Blue Cross Blue Shield of Michigan.
By Allan Chernoff
CNN Sr. Correspondent

When Theresa Langlois read her insurance statement she knew her podiatrist had been cheating Blue Cross Blue Shield of Michigan.

"It was like robbery," said Langlois.

She had visited Dr. Jeffrey Cooke to have her discolored big toe examined. Cooke billed the insurance company thousands of dollars, claiming he had surgically removed dozens of warts.

"I turned the bill over and there was a fraud hot line, directly to Blue Cross to report fraud. So I called that immediately," said Langlois.

The insurer audited Cooke's billings, interviewed Langlois and other patients who had seen Cooke, then contacted law enforcement, which ultimately led to Cooke's arrest, conviction on health care fraud charges, and imprisonment. Blue Cross Blue Shield of Michigan won a restitution award of $273,000.

"We open about 1,500 cases a year for in-depth investigation," said Greg Anderson, who heads Blue Cross Blue Shield of Michigan's Special Investigative Unit devoted to tracking down corrupt doctors and pharmacists. "They're taking money out of our pocket and depriving people who need the actual service. There's only so much money in the pie to go around when people are taking it."

Health care fraud – perpetrated by physicians, hospitals, medical equipment providers and even organized crime gangs – is rampant. A Senate investigation found Medicaid between 2000 and 2007 paid nearly half-a-million claims to people posing as doctors who were dead.

Such fraud costs every American; driving up prices for medical insurance, treatment and drugs.

"It's just a domino effect that ends up with the consumer. Somebody's got to reimburse for it, somebody's got to fund that and ultimately it gets passed down," said Douglas Falduto, director of the Special Investigations Unit at Horizon Blue Cross Blue Shield of New Jersey.

The National Health Care Anti-Fraud Association estimates fraud accounts for a minimum of 3% of all health care spending: $72 billion a year.

"That's a conservative estimate," said Association Executive Director Louis Saccoccio. "It's a cost drain."

Other experts say fraud may account for 10% or more of health care spending.

"We don't actually know the dollar amount being lost but we know the order of magnitude. It's hundreds of billions of dollars. We just don't know how many hundreds of billions of dollars," said Harvard Professor Malcolm Sparrow, author of License to Steal: How Fraud Bleeds Americas Health Care System.

President Obama warns health care reform is necessary to get medical costs under control.

"If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket," the president said July 22 during a press conference to promote his health reform initiative.

But one of the key factors driving higher costs – fraud – is getting little mention in Washington's reform effort.

"They are certainly aware of this problem. They don't seem to know the magnitude or the seriousness. They don't seem to be acting with the kind of urgency that I would like," said Professor Sparrow.

The health reform bill approved in the House, "America's Affordable Health Choices Act of 2009" – 1018 pages long – devotes only 40 pages to the issue of fraud. This and other bills still under discussion in the Senate would allocate just $100 million dollars a year to combat fraud, waste and abuse. That's the amount of health care fraud occurring in this country every 12 hours, using the most conservative estimates.

Experts warn that if fraud isn't addressed more aggressively American taxpayers will be paying billions more than necessary to provide health insurance for those who don't have it.


Filed under: Health • Politics
soundoff (202 Responses)
  1. joseph e. gaskins

    I been watching town hall meeting across the state on tv seam like to me that peoples are getting mad with each other for nothing, because every american need healthcare. If the america peoples dont come together on one issues, we are sitting a bad example to the other countries. Because we are going to start a war among each others, and that is bad for the America Peoples. Instead we sending troops to Afqhanistan we are going to need thems here at home, because the america peoples are getting out of control about the issue of healthcare.

    August 19, 2009 at 4:02 pm |
  2. lee4

    Health care in the United States is filled with fraud and the people at the townhall meetings are "ringers" brought in to try to keep it from passing. They are rude bullies that have much to lose if the government takes it over. They are groups that bilk the government everyday and citizens need to realize you are being robbed. Insurance companies decide what healthcare you should receive, it is certainly not the doctor treating you. Many say, 'we have the best care in the world, people we are ranked 37th in the world and spend more money than most of them. Wake up, next they will be after your medicare and social security.

    August 15, 2009 at 12:25 pm |
  3. Eric W

    You know, the more that I think about this, what if the government subsidized malpractice claims? Free med-mal insurance, no more defensive medicine. Sort of like the FDIC? I'll just bet costs would go down that way as soon as the lawyers saw they would have to go to the government for claims. It surely would cost less than the health care bill.

    Hey if they can spen 2 Billion dollars on "cash for clunkers" what about this? I'll bet you would see costs drop dramatically.

    August 10, 2009 at 8:18 pm |
  4. Eric W

    As a health care provider I believe medical costs are rising not so much because of fraud on the part of the health care providers, but as previously stated because of the defensive medicine that we must provide to avoid the attorneys. Just look at the ads on TV now for one drug or the other. Costs of these medications skyrocket due to product liability. Uneccessary testing is not that so much but merely to prevent another thing the attorney can bring out if and when a malpractice case comes around. 9 times out of 10 we know what the problem is, but if we don't order that expensive MRI, or full blood panel the attorney will surely jump on that. They will also easily find a so called "expert" who is hired to attest to it at $1500 per hour or more. Then you will have to find your so called "expert" to refute that at the same price. Finally it will go to a jury being paid $30 per day +lunch to decide who is right or wrong.

    Great system we have isn't it? The attorneys laugh all the way to the bank and we as health care providers have to take it. Why is that......simple, we are easy targets!

    August 10, 2009 at 8:55 am |
  5. Dr. Ralph E. Ioimo, PhD

    Unfortunately, the healthcare issue has sparked significant debate. Most of which has been dishonest information intended to incite the less informed people in our society. The facts are, the United States ranks 30th in the world in terms of life expectancy. Most of the countries that have government supported healthcare have longer life expectancies, e.g. Canada, Great Brittan, Germany, Australia and many others. Most of the countries that have government supported healthcare spend a fraction on healthcare was we do in the United States. The healthcare problem continues to grow in this country and costs continue to rise.

    I am also appalled at the comments that try to draw NAZI parrallels to this issue and inferring our president is a NAZI. This again shows complete ignorance. NAZIism is the ultimate form of conservatism not liberalism yet many try to draw inference to the democrats and NAZIs. I am concerned about this because it is inciting the less informed in our society.

    I encourage people to read and learn about both of these issues as they are critical to our country. Something has to be done about healthcare in this country. Legitimate debate is not only necessary but helpful in resolving this issue, however, we need to remove this type of misinformation and down right ignorance from this debate.

    August 10, 2009 at 8:48 am |
  6. jay m

    The protester that are showing up at these townhall meeting are being sent by the mob, the Republican mob.

    August 10, 2009 at 8:19 am |
  7. rodge b

    What makes a priest differ from a doctor? A congressman from a CEO? A cop from a felon?....well, my friend it's hard to find one so we need to have a reform in place and keep reporting to the media which I
    trust a little bit better than the Congress and the Senate!

    Don't pretend you have something in your pocket, it doesn't make sense......

    August 10, 2009 at 7:42 am |
  8. Mike E

    We have laws against fraud.

    Saying that we should not pass health care reform until all fraud is eliminated is like saying we should stop building any roads and highways until drunk driving is eliminated.

    August 10, 2009 at 7:35 am |
  9. Claudette

    Supporters of President Obama's healthcare reform were out in numbers at the St. Petersburg, Florida Library. No screaming, just real people who understand the need for healthcare reform.

    Strangers willing signed petitions in support of healthcare reform, all seem to understand the need and that the time is now.

    We can not allow premiums to increase with less coverage each year. A public option will force insurance companies to compete for our business.

    Medicare will stop paying insurance companies billions for failed management, making more medicare money available to Americans.

    People like my disabled daughter will be eligible for healthcare coverage under a public option.

    Do not let the lobbyist kill healthcare with lies. America does not kill the elderly or deny healthcare to the sick.

    NOW IS THE TIME, CALL OR VISIT YOUR REPRESENTIVES OFFICE IN SUPPORT OF HEALTHCARE REFORM.

    August 9, 2009 at 4:23 pm |
  10. Bernice

    Stop the fraud totally, but don't destroy the best medical system in the world! There went our jobs! There went our auto industry, there goes the medical? Come one and wake up! Most are now! EDUCATE YOURSELVES QUICKLY! As Americans, we have way too much to lose, and I have lost way too much since this administration has taken office ALREADY!

    August 9, 2009 at 7:34 am |
  11. Mr.Black Hollow

    There are many unfavorble matter in our life.However,your case is one of the most complicated issue among group of them.Medicine is one of the most important carreer in our society and doctor is also one of the most important person.For me,the more improving the society is,the more difficult the medicine need to try.So,in my understanding,i am always convinced that,doctor will be try so hard to satisfy and save the human's life.

    August 8, 2009 at 10:52 pm |
  12. Walt O

    The FBI only recovers about $1 billion a year in health care fraud because they are under staffed and lack the skills to electronically audit billions of health care claims. If we stop health care fraud, we can provide coverage to all the uninsured without raising anyone's taxes. I would rather pay for 10,000 more FBI agents than $100 billion a year in fraud.

    What can ordinary citizens do about fraud? File a False Claims Act case if it involves government dollars – Medicare, Medicare Advantage, Medicaid, SCHIP, Worker's Comp. If you have a good case, you can get a lawyer without up-front fees and the fraudlent party will have to pay triple damages.

    August 8, 2009 at 9:40 am |
  13. EDMOND W MARTIN

    You know we hear lots of BS from the radical right wing domestic terrorists about health care , especially keeping government out of it. But Medicare and COBRA are Both already under government control or policies . If you say NO TO COBRA just think How many more will be without insurance. I'm on it now after being laid off the 2nd time in 8 years of work at Cessna . The 1st time was caused by failed Bush policy post 9/11 ,that kept us unable to fly & sell our aircraft for weeks. The 2nd time also due to Bush falied policies or lack of regulation of BIG OIL, HOUSING AND BANKING INDUSTRIES causing the economic meltdown . No body speaks the truth of why, just like the auto industry we have been sunk By Bush in aviation twice in 7- 8 years.

    August 8, 2009 at 1:52 am |
  14. Marjorie Hogeboom

    Reform in our healthcare system may be warrented and there is no need to overhaul the whole system when a national healthcare system already exists, Medicare and Medicaid. Instead of constructing a system that still leaves millions uninsured, lets implement changes in our current system to control costs and cover more people. Additionally, we need to return to regulating the insurance industry rather than regulating American citizens ability to access with efficiency the best healthcare the world has to offer. ( How about going back to regulating gas prices as well. ) If and how this is all done, it must be done in such a way that provides for the needs of those unable to work for coverage due to disability and eases the financial burden of high deductible coverage on the working class which essentially leaves many of us that support the financing of the entire system with little more than catastrophic coverage. Those people that choose to spend their life sitting, watching TV and collecting government checks must be held accountable somehow rather that sucking the life out of the rest of us.

    August 8, 2009 at 12:33 am |
  15. Dman

    I always find it interesting that opponents to health care reform argue that it will be the "death to all of us" or "it will restrict our choices" or "medical decisions will be made by bureaucrats".

    It is the current unregulated capitalistic private insurance companies who are actually fulfilling their worst nightmare right now. "Death to us all" – private insurance companies are literally killing patients right now by denying lifesaving care like in the case of Cigna's denial of Natalie Sarkisyan's care.

    "It will restrict our choices" which is exactly what our private insurers are doing. I have private coverage myself as a medical professional through my hospital who employs me. I'm restricted to a list of doctors I can see and also to only 4 hospitals in the local Tampa Bay area and if I seek medical care outside of this my insurer will put a majority of the financial cost on me so if I want somewhat affordable medical care I'm forced into their restrictive measures.

    "Medical decisions will be made by bureaucrats" – in the private insurance market medical decisions aren't made by myself or my doctor but rather by bureaucrats (executives and internal business analysts) from my private insurers when they decide what is covered and what is not.

    Healthcare reform would put a stop to all this and I've actually researched for hours on what the best way to achieve this is. Here's my solutions – http://bit.ly/9QLV8

    August 7, 2009 at 8:47 pm |
  16. grimjack

    C'mon people. Educate yourself. Fraud will never be completely stopped. Just like banks will continue to be robbed, cars will be stolen, people will be murdered.... You would have to eliminate greed first, wouldn't you?

    Pre-existing is an essential insurance concept. Why would you ever buy insurance unless you were sick? Because of pre-existing. Otherwise, you could wait until you were sick. You wouldn't expect an insurer to sell you a life insurance policy after you died, would you? Why should an insurer sell you a policy after you are sick? (Unless it is group health under your employer).

    August 7, 2009 at 5:41 pm |
  17. Scott

    Disney World has 45 million people every year who enter the park to see Mickey by putting their finger on a biometric (fingerprint) device. Over 1 million elementary school children pay for school lunches using the same technology. A huge percentage of fraud is physicians billing for services never rendered where the patient never physically entered the office for treatment. The biometric would confirm patient presence (eliminating fraud) protect the honest (99%) physicians from liability and medical ID theft (can't pretend to be another patient to use their benefit card) and patients from unknowing medical ID theft. Other countries use this technology all the time. The fingerprint is not stored like in a police fingerprint, it is converted to a computer template which can't be reverse engineered to protect patient privacy. When we go to the dr, we are representing we are at the medical office anyway, why not "Give Fraud the Finger" and use biometrics?

    August 7, 2009 at 4:17 pm |
  18. kelly

    Healthcare is not the only thing out of control. This could be fixed by regulating the insurance companies as they have so freely done with the banks, aig, gm. We do not need everyone under one restrictive plan. Fraud? Medicare, medicaid, va, all private health insurance co. have a fraud unit. I suggest they put them to work for their paychecks.
    Torte reform for all the lazy non compliant people that want to just get rich off their Physicians.
    The way this bill is structure is if there are anychanges what so ever in your coverage or premiums you will have to go to the government coverage. Now if they can't handle medicare, medicaid and the va how the hell are they going to take care of 50 million more applicants?
    I am still reading the bill. Waiting to find the part where all of Congress is exempt of these rules. It has to be in there or they would all be willing to carry the same coverage they are offering us.

    August 7, 2009 at 3:39 pm |
  19. D Green

    There are many more of us who have discovered that our health care professionals were commiting fraud with our medical benefits. Once I was absolutely sure that the medical claims filed to my insurer were
    fraudulent, I reported to my insurance company. They encouraged me to report to the state professional board which I did. They acknowledged many complaints about the same physician. After a long investigation I was told that the case had been elevated to the State Dist Attorney's office. The doctor is still in business and nothing has been done about the fraudulent business activities. This doctor
    still refuses to return over $5000.00 of a deposit for services not performed. I did not feel confortable to continue seeing the doctor after finding out about the many complaints and dishonesty . Is there anyone who can assist me to reveal this situation so others will not be violated by this doctor as I was?

    August 7, 2009 at 2:46 pm |
  20. KC

    IT LOOKS TO ME LIKE THERESA NEEDS TO COME BACK TO MICHIGAN TO VISIT HER FRIENDS AND FAMILY!!!!!

    August 7, 2009 at 2:44 pm |
  21. J. Randall

    This is why we need government supported public options, run much like the FAA to insure our safety. It may not be a perfect bill, but after reading it, looks to be a major improvement. As for wasted money's, man I worked in the purchasing department of the 3rd largest Ins. company in the world, and what a mess. They bought and tossed stuff out like there was no end to thier customers money. If you think they're well run, just take a look at how long it takes, and how accurate your bills really are. We need this reform! People with pre-existing conditions, and the list for this is growing, are dying everyday for no reason. The commercials on TV stating really low rates like Health One, never point to the deductibles or condition exclusions. They state starting at 63 dollars, it almost fraud the small print. Let's see them Insure me for that amount! NO WAY

    August 7, 2009 at 2:44 pm |
  22. Jon

    Fixing Fraud is important and tort reform are important, and you have to give some credit to Republicans for seeming to care more about this than Democrats. Insurance is mostly regulated by states, and most tort cases are brought in State Courts. There are no shortage of states which have been governed by Republicans exclusively for the past 10-20 years. Have they enacted tort reform? Is fraud lesser in Republican dominated states than Democratic ones? Why might that be. I'm actually asking the question because I don't know the answer. I do know this: Republicans controlled the House, Senate and White House for periods of time over the past 20 years and I don't recall a bill introduced on the subject. I'm starting to worry about whether or not some of this talk is more excuse-aking to not reform the system.

    August 7, 2009 at 2:20 pm |
  23. mike

    I agree we should fix the fraud first. I think anyone who has ever been to a dentist's office has been the victim of fraud. Dental Assistant: "Your TWO insurance programs don't cover this bridge...so you have to pay $2300, EVEN WITH TWO INSURANCE PLANS!"

    Patient(me): "Is that your way of saying the dentist needs me to help him with his downpayment on his BMW?"

    August 7, 2009 at 1:37 pm |
  24. James

    If our president and politicians (senate & House) are under the same program as we the people then I will consider what they have to say, but not until!

    August 7, 2009 at 1:25 pm |
  25. charlie

    Larry, did you not read the article, Obama is not going to fund fraud prevention enough to make a dent. Look at the Medicaid program. Why do you think the government will fight fraud better than insurance companies

    August 7, 2009 at 1:18 pm |
  26. charlie

    In reading all of the comments made about this issue, no one has ever said what "affordable" means. Obama says he wants health care that is affordable to everyone. What does that mean? Tell me a dollar amount that I can fit into my budget. There is no way we are going to get more health care for less than it is costing today. Nothing is free. With health care reform some of us may end up paying less, but a lot of us will pay more! How can anyone listen to this debate and not wonder where all the money is going to come from to provide health coverage for all? And now Pelosi is calling the health insurance companies immoral villians! Listen, if you had a claim denied for a service that was covered by your plan, get a lawyer and sue. Most of these complaints are from people who did not bother to read their coverage details.

    August 7, 2009 at 1:15 pm |
  27. Dave

    Andra..

    in your long spiel about how it takes 'real leadership to change the way we spend existing money' you fail to realize that much of the reform is going to effect the way we spend at the root.

    Getting everyone covered by health insurance will allow them to have affordable regular checkups – and is the most important 'preventative' measure of all. If any of you feel that 'defensive' medicine / 'preventative' medicine is the key to reducing costs – this is the first line of defense.

    Not only does that reduce costs by preventing later illnesses... it increases economic stability by keeping these people in the work force. It also means people will not end up in emergency rooms over a relatively small problem..

    This is only one aspect... but to give an example I've recently gone to the dentist – I haven't had health insurance of any kind for a long time.. if I had been getting continual checkups – I would have saved myself significant money – and also sick time. To repeat my main point – the most important cost reduction of all is getting people insured and into the doctor's office regularly.

    August 7, 2009 at 1:07 pm |
  28. Paurav

    I believe that most doctors commits fraud to some extent. They use wrong codes when charging the insurance company to squeeze out a little money. It sickens me to see people going into such a profession for money.

    August 7, 2009 at 12:56 pm |
  29. cynthia kolb

    This is a huge complex problem, there is no answer that will solve everything and please everyone...that doesn't mean we shouldn't try. This issue has been around for decades but for 8 years we didn't talk about it and its gotten worse. Now we have millions of Americans out of work and out of health care for the first time...its easy for the insured to be resistant, but I can tell you as one of the newly uninsured it is a very scary and expensive thing, nobody in America should have to go through this when we spend more than this on wars

    August 7, 2009 at 12:54 pm |
  30. Dave

    Medicare and Medicaid work well.. anything can be 'improved' though.. but this view that they 'don't work' is a myth.. they're extremely low cost especially when considering they are providing health care for the most expensive segment of society – the elderly and the low income.

    August 7, 2009 at 12:51 pm |
  31. Chloe

    Yes we need to fix these problems, but if you think things are bad now turning Health Care over to the Government will be worse. Name one program that the Government runs that is a success? Our Health Care is not perfect but it is the best in the World, so why change it when 80% of the people are happy with their Health Plans, and the 48 Millions who don't have Health Care either don't want it or don't want to pay for it or are illegals who are getting it free anyway.

    August 7, 2009 at 12:41 pm |
  32. Larry T Williams

    Yes, their is fraud committed with doctors, but the way insurance refuse to pay for medical services is also fraud, but it is legal fraud.

    August 7, 2009 at 12:22 pm |
  33. Republican not against health care reform

    It always surprises me to see the constant "with us or against us" stance presented by everyone ranging from politicians down to commenter on this post. Just because you want to reform healthcare doesn't mean your solution will work. Most Republicans aren't against healthcare reform, they're against a reckless policy proposed by the Democrats. I believe that we need health care reform, I just don't trust our government to do it correctly by going deeper into the insurance business beyond Medicare. Why do we need a public option when we can simply pass laws and more rigorously enforce laws. You can eliminate the insurance industry's disgusting practices such as rescission, pre-existing conditions, and other abuses by simply identifying the abuses and passing laws to eliminate them. If the insurance business wants to continue, they'll have to comply. Then give the federal government power (not the states) the tasks of enforcing those laws, and rooting out fraud. Finally, I'll gladly pay more taxes to cover the under-insured and the un-insured, I just don't want to pay for the bureaucratic overhead that it will take to administer a public option. So expand medicaid or allow the government to broker a health plan with private insurers for the un-insured using our tax dollars. I don't see why our politicians are making it more difficult than that.

    It is truly appalling that they do not read the bills they sign though, no wonder our tax dollars go to waste in earmarks.

    August 7, 2009 at 12:06 pm |
  34. Blake Wright

    Michael Menzel, You have hit the nail on the head... the hell with paying insurance premiums... As a healthcare employer with 38 employees, I pay over $120K out of my pocket every year to insurance premiums for my employees... If I could I would pay that money directly to the employees and let them decide where to spend it... the problem is ... PREXISTING CONDITIONS.... Insurance companies are nothing more than a legal mafia. they can make any rules they want and they have everyone by the b-s!

    August 7, 2009 at 11:56 am |
  35. Rick McDaniel

    This is exactly what government does nothing about, and why government health care is a very bad idea. The UK NHS is a prime example of the problems in national health care.

    August 7, 2009 at 11:54 am |
  36. mike

    lyn,

    your story is horrible and i hope for the best for you and your family.

    have you attempted to get medicare because of your disability? that may be the best of bad situations?

    Also what about ARRA? Have you used the COBRA subsidy by the government??

    I expect that program to continue as long as unemployment is as bad as it is. Pretty soon many people using the 65% subsidy will reach the end of their 9 month period and will either lose coverage (due to not being able to pay expensive COBRA premiums) or see those costs skyrocket to amounts no one could afford.

    something does need to be done. its been needed for years and now its at the forefront. Its just sad it all had to come to this to get it out in the open.

    August 7, 2009 at 11:49 am |
  37. Michael Menzel

    I love when people talk about personal choices which supposedly free market system provides comparing to Cuba or Canada, or even maybe USSR...

    But we do not have any choice at all!

    People! My employer pays to insurance company $20,000 a year for my family plan. And my family is pretty healthy (we spend barely $1000 a year for doctors visits).

    Why cannot my employer increase my salary for that $20,000 a year and give me REAL ABILITY TO MAKE MY OWN CHOICES, or even save this money for future when I'll be older and sick!

    No, "free market" system of this country made health insurance manadatory for employers.

    When you understend how real free market works we'll be out of this mess.

    August 7, 2009 at 11:30 am |
  38. Ed

    TAlk about fraud? Medicare health providers such as mail order suppliers of durable medical equipment are the biggest perpetrator!
    Medicare is a open door for anyone to grab in pull out tons of money! The government needs to clean up it on act before it say that the private sector should . It's no wondeer medicare is loosing so much money!

    August 7, 2009 at 11:21 am |
  39. Dennis

    Get over it conservatives. You are going to lose this one just like you lost the election. You can organize and disrupt the town hall meetings. You can, along with your Fox news station, cry out in agony as the wheels of change roll forward and fix the problems created by your president and your congress that were for the most part voted out of office. No matter how much Rick Scott and his minions at Conservatives for Patients Rights or Dick Army and his minions at Freedom Works want to kick and scream, the American people will get an improved healthcare system. You have screwed this country and the world long enough. We are taking it back.

    August 7, 2009 at 11:15 am |
  40. mike

    insurance companies profit margins in 2008 were 2%

    pharmecutical industry profit margins in 2008 were 18.5%

    exactly WHO is the devil here?

    billy tauzin that's who

    August 7, 2009 at 10:46 am |
  41. Reggie

    I have reported some fraud to BCBS of NC. The company I work for is self ensured and that come cost come out of their bottom line. That will cause my rates to go up and even reduce raises. Fraud hurts in many ways.

    August 7, 2009 at 10:45 am |
  42. lyn

    I am a nurse, or rather I was one. I worked at a great hospital in labor and delivery. I carried my families health ins. ,which was expensive ,but terrific coverage. I am 58 years old and planned on working many more years. I was like all these people who are happy with their coverage. How quickly things can change. My headaches drove my quest to find a cause and accendently discovered an aneruysm in my brain. One month later I had surgery and it ruptured as they were putting me to sleep. I had a severe SAH, which has left me unable to be a nurse. this was Jan. 2008. My husband lost his job caring for me. I am on LTD and SS disability which doesn't cover our expenses. I chose cobra for myself and not my family because of cost. Now with only 2 months cobra left I can find no company to cover ME for less than 1200.00 a month and a deducitable of 3500(thru hippa). I had trouble with the 500.00 for cobra!. My husband has no ins. and my daughter loses her fl. healthy kids early next year. my husband still has no job, we rent and can't afford to move... you just never know when it could be your turn to become uninsurable. I never imagined how quickly my circumstances could change. All healthcare without an agreement with an ins. company is so expensive I guess we will be among the ER visitors. So those of you out there who yell about health care reform beware...you could be next.

    August 7, 2009 at 10:45 am |
  43. Blake Wright

    It is pathetic to hear people blame doctors and health care providers for the problems with our healthcare system... I know there are corrupt people in every industry (including doctors) but the real story is that physicians must battle constantly to get reimbused enough to pay salaries, licenses, malpractice insurance, and all the other regulation fees and all the other BS that goes along with trying to run a straight practice and really help people who are sick... Keep in mind that physicians and providers provide many services throughout the day that they never get paid for such as calling in refill prescriptions, writing letters to patients or other physicians, sending med records to other physicians, and the list goes on... there are no codes to bill for these services so they are provided for nothing... My attorney charges me $68 to OPEN AN EMAIL even if it is 1 line... he charges $68 to send me an email, and $68 for a phone call even if it is 20 seconds long... If doctors (who are really trying to help people) could charge what attorneys charge... there would be few, if any, problems with healthcare at all...

    If people would pay doctors instead of insurance companies there would be NO FRAUD because the patient would have the say so as to whether he or she wants to have the services recommended...
    If there were no insurance companies, people would pay for services just like they do for a haircut or an oil change... Does healthcare cost a lot? absolutely!!! Doctors go to school for at least 8 years, sometimes 12, to acquire the knowledge necessary for their profession. Now, people act like the doctors are the problem and that they are always ripping off t heir patients... Keep thinking that way... soon there will be no doctors to take your sick kids to, or to refill your prescriptions for free, or to perform that surgery on the malignant tumor you have... NOBODY WANTS TO BE A DOCTOR ANYMORE!!! Why should they? the insurance companies and lawyers get all the money..... If people would count up all the money that they spend in insurance premiums (including businesses who pay for employee premiums) everyone could pay for their healthcare directly...
    The only people who want healthcare reform are those who want someone else to pay for their healthcare... Until all the insurance companies in this country are gone, and people can start paying doctors for their services again, healthcare problems will do nothing but increase, and I promise you, from a healthcare providers POV, the plan that NOBAMA has is ridiculous... what doctor wants to get 8 -12 years of education and then have to scrape to get reimbursed from some government healthcare policy... What will happen is that all the crappy doctors who dont give a rats butt will be the only ones to take the socialistic insurance, so all you people who think that govenment healthcare is the answer, you can go see all the crappy doctors... I mean, lets be realistic... if you go down to your local health clinic or to the ER at the county hospital, they have to treat you whether you have insurance or not... if you cant pay for it, the govenment does...! what kind of doctors do you see in these places? All the ones who cant get jobs at decent practices or hospitals.... And guess what? because they have to live on medicaid reimbursements (which are almost nothing) or wait to get reimbursed from the government, THEY DONT GIVE A CRAP ABOUT YOUR HEALTH!!!!!

    As for us, we will never take it, and we will continue to provide EXCELLENT healthcare to our patients who are willing to pay for it... and for those who say they cant afford it... THIS IS AMERICA... you know... FREE ENTERPRISE!!!! that means that you have to work harder to have more... You get what you pay for... Healthcare included....!!!
    Again, my opinon is that insurance companies are the entire problem and as soon as they are gone this country will have fewer healthcare problems... People will want to be doctors again when they know that they can make GOOD money for providing GOOD medical care to patients who are wiling to pay for it... !!!!!!!!

    August 7, 2009 at 10:41 am |
  44. Brett

    Larry, the current health care "reform" debate is not about reducing fraud. It is about getting non-Obama voters to pay for the government-run health care for Obama voters. If the legislation being advanced in congress were about reducing fraud, and not about a government takeover of medicine, then everybody would be happy.

    August 7, 2009 at 10:37 am |
  45. Charles A. Bishop

    Today's Wall Street Journal has an interesting article on the health care system in France. The French system is rated number one in the world, By comparison, the US system is rated 37th. The French system, however, is not without problems, the main one being high costs that are forcing the government to cut services. A universal single payer government system like that in France, Canada and much of Europe would help to eliminate fraud by providing greater transparency. In addition to being universal, it would also be cheaper and more efficient. But there is room for the private sector too. For example, in Canada where there is a government system, hospitals are privately owned and operated. Americans, however, are afraid of the Canadian type system because waiting time and lack of services there are a problem. One solution might be a small user fee which would add substantially to the revenue, and eliminate many unnecessary hospital visits, and fraud. It is hoped that we will soon get past the bickering in Congress and do something. 37th place is pretty poor!

    August 7, 2009 at 10:34 am |
  46. Brian

    I have a hard time when people say "Look at Sweden, look at Australia, etc" about health care. The problem with that is the population size. I can see how government run health care is affective and successful in small populations where costs can be kept down. But to try to provide it in a system the size of the United States is a completely different story – look at Canada – competition makes for better service. I fully agree we need reform and maybe reform isnt' the correct word. I agree that insurance costs are out of control – so control it. Put limits on insurance costs, regulate medical costs and expenses, add some oversight. I have a problem with the taxpayers, "myself," paying for the healthcare of others, those who are making unhealthy choices that lead to their need of the healthcare. I support healthcare for those who cannot support themselves, ie children. If our children are healthy to begin with, many of our health problems as they become adults are simplified or eliminated.

    Why not regulate insurance and medical costs and provide incentives to be healthier. Like they are doing with the CARS program, why not provide rebates or stimulus for becoming healthier, give a reason for people to get that way....if we become a healthier society, costs will naturally go down.

    These are all certainly random thoughts and ramblings, fleeting ideas, thoughts to ponder. I am for change, but it needs to actually be change and not just a quick fix.

    August 7, 2009 at 10:32 am |
  47. mike

    Lance,

    thank you for doing what you do.

    I do realize that insurers are the forefront on cost cutting measures like wellness initiatives long before Obama started touting them. Disease case management like you do before they started talking about them.

    i love how their "comparative effectiveness research" on drugs is nothing more than step therapy that insurers have been doing for years.

    These are cost saving measures that insurers try to do to save POLICYHOLDERS money, you know why? because al of us who work at insurers or in the industry have a stake in it.

    And if you destroy the industry that has 2.5 million jobs how bad will the economy be then?

    But yes we can all go get government work. that lately seems to be the answer to everything.

    The answer should be why Mr Obama isn't talking about the 70% of american children that are obese.

    That figure is staggering and NEVER gets talked about.

    August 7, 2009 at 10:29 am |
  48. Mike

    I think that physician fraud is part of the problem, but a small issue compared to insurance company profits. Before people gang up on the "rich doctor" one should realize that most primary care doctors don't make close to 200k, let alone more. One must also look at the years and debt accured before gaining a full salary. Most physicians leave med school 150k in debt and work 80+ hours for 3-5 years at 35k/year before they even get to make their final salary. Once making 150k per year they have to pay off their debt (which grew during those 3-5 years) and alot 30-50k per year to repayment of debt. After all is said and done take home is closer to 80-90k for that primary care doctor who answers your calls at all hours. I think greed is part of the problems, but for the most part I think physicians are trying to do right by you.

    August 7, 2009 at 10:29 am |
  49. alan

    Lance that's just the problem, you work for the insurance company. Like you are one we would look to for honest responses. These insurances copmpanies are out for blood and profit.

    August 7, 2009 at 10:26 am |
  50. JOHN

    Fraud and fraudulent legal actions ought to be managed; however, a complete overhaul of the system is unnecessary. We do not want a single payer program.

    August 7, 2009 at 10:24 am |
  51. Cris

    I saw sicko but, I am also cuban. That gives me a uniquely different perspective, because I know what is really going on in socialized medical systems. As much as liberals want to critique capitalism and republicans, they don't want to live in Cuba, even with its universal health care. Maybe because there are no medications there...or CT scans or anything else, including food or decent housing. When the government takes over, they will turn healthcare into a rationed program where only certain groups get this or that and personal choice will be history.

    August 7, 2009 at 10:18 am |
  52. Julian

    We need healthcare reform based on a public option. My healthcare and my family’s healthcare must not be based on profit making ideology. This ideology and the monopoly of the Insurance companies is what drive the prices sky-high. The “market forces” and “self-regulation” stories that we are told will drive down the costs, are bedtime stories, a bad joke, and do not work – see the meltdown of the financial market, no market forces, only greed – as long as there is no independent regulatory function. It is not conceivable in our times to have people that do not have health coverage, under-covered, etc.
    It is not conceivable to be denied health care for pre-existing conditions it is not conceivable to receive treatment base on what is most profitable procedure instead on what is the most effective, and is not conceivable to pay out-of-control services. Just to mention a few from my personal experience: 10 miles with an ambulance having paramedics doing nothing of real help – $1700. Equivalent to about 80 taxicabs. One bandage wrap in the doctor’s cabinet called “surgical care”, 5min, $85.00. This would be equivalent to $1020/hour. This is not medical care. This is simply robbery.

    August 7, 2009 at 10:18 am |
  53. RobK

    Insurance is the main cause of the broken health care system. The best solution is having the consumer pay the health care provider directly. If you are paying with cash out of your pocket, would you pay a hospital $10 for a Tylenol? But what if the insurance company is paying for it? Then you don't care.

    August 7, 2009 at 10:09 am |
  54. Chuck

    Thank God there's no chance of fraud or overspending within a Gov't run program. I'm feeling much better knowing that Pelosi, Reed, Dodd, Franks, Rangle, Geitner – such upstanding and honest and reputable politicians will be looking after my best interests.

    There's certainly no chance that they would stoop so low to take money from Insurance Companies, the AMA, AARP, or any other organization that tries to buy influnce.

    Pass the Bill today!!!!! errrr.. .then wait in line tomorrow for your Kool-Aid tomorrow... even that will probably rationed shortly...

    On a positive note – you guys are giving me hope.. I didn't know that there were so many guillable people in American... time for me to start selling snake oil... there' s obviously a HUGE market for it..

    August 7, 2009 at 10:08 am |
  55. George

    Folks tend to look at one issue, and not the whole picture.

    For instance, the health care payment system needs reform. We have the best health care in the world, why can't people access it? Expense.

    So, we need to reform the cost, and some of the service. Why is it so expensive? One of many issues: Greed. Health care insurers are making billions in profit. Fraud. Lawsuits.
    From this we need to change our legal system in tort reform. Yes a person was injured, but should they as an individual receive millions in compensation? How does that hurt our system? How do the hundreds of thousands of frivolous lawsuits hurt, not only health care, but every facet of our lives. Our legal system – notice I don't use the word justice – must be reformed.
    Profits must be regulated and limited. Fraud must be controlled.
    The government should not be in any business; it is there to create and enforce a level and fair playing field for business and capitalism to exist.
    Name one program -one government program that functions efficiently, and accomplishes the task for which it was created. Yet somehow we expect it to run healthcare? No. It needs to reform health care laws, and stay out of the business. Further, it needs to get out of the banking and auto industries, and get back to the job it was intended; creating fair and just laws that give everyone a fair shot at the "pursuit of happiness".
    It does not matter if you're Democrat or Republican, Obama hater, Bush hater, whatever. We're all Americans; united we stand divided we fall. Our leadership on both sides of the isle have failed us, and not just in the past decade, but decades. We the people need to stop repeatedly electing lawyers to government who consistently support their own. All of these people are celebrities; they don't have to worry at all about day to day income or expenses that they are so far out of touch with us real folks as Hollywood.

    August 7, 2009 at 10:06 am |
  56. nave

    I have dealt with BCBS many times where I have tried to save them and myself money but found that they were not interested. Something they didn’t cover or was not in my policy, but was cheaper, had been denied in favor of a procedure that was more costly to the both of us. Also all of the fighting that I have to do to prove necessity of a procedure that I have had done which was eventually covered never compensated me for my time. Morally I know this is wrong but BCBS has taught me a valuable lesson. I will take “their” attitude and unless my policy stipulates that I am required to review my bills and must report this to the proper authorities I will let it occur. Maybe insurance companies should offer a type of “reward” for reporting, leading to a conviction of fraud to get people to see what is in it for them. I don’t believe the “it adds cost to everyone’s insurance” as much as I believe ending fraud adds more to the insurance companies profit and bonus’s for their execs. They would not lower costs to the member’s just find another excuse to raise costs.

    August 7, 2009 at 10:06 am |
  57. RobK

    A government option would be fine – as long as no tax dollars are used to support it. We will see if the government can run things more efficiently than private enterprise. We have an example: Post Office vs. FedEx and UPS.

    August 7, 2009 at 10:04 am |
  58. wm

    My suggestion would be for all govenment employees including the president and congress to try out President Obama's public option first. If it works – great – then the rest of us will feel better about it. Instead President Obama, members of congress and government employees crafting the bill will keep their current health care with private carriers, but use small business as the guinea pig.

    August 7, 2009 at 10:03 am |
  59. Jody Madden

    To inform the very uninformed regarding healthcare reform: while tort reform and malpractice insurance should be a part of healthcare reform in general, it is not the most pressing part of the problem. Out of the 2.5 trillion dollars per year floating around in US healthcare, only 1% is involved in malpractice insurance, lawsuits, and patient awards and settlements. While it's no small amount of money, it's not the primary problem.

    We need to have coverage for the uninsured and under-insured. We need to have a system that looks at effective outcomes rather than whatever the latest techno gadget is that looks great, but does not produce cost effective outcomes. We need to stop spending billions on patients who are not going to have a reasonable quality of life.

    August 7, 2009 at 10:03 am |
  60. Steve, Columbia SC

    Steve with the hyperextended knee...............please understand why I don't like what's being proposed.

    I am a charitable person, wanting to help those in need. I just don't want an inefficient, wasteful government taking my income to provide that charity, totally removing me from the equation and giving more charity than I would, deciding who gets charity and who doesn't. The government will be making the same hard decisions being made by insurance companies. It's socialism any way you slice it.

    I also don't want to pay for abortions or sex change operations.

    August 7, 2009 at 10:01 am |
  61. BML,MD

    One must be careful with what is called fraud by our government. If a physician tells an elderly patient who cannot afford care that he will accept only what Medicare pays and forgive any co-pay,he is committing fraud.Does that sound like fraud or an act of kindness?

    August 7, 2009 at 10:01 am |
  62. stef

    They are also forgetting frivolous lawsuits, malpractice is a huge expense, and defensive medicine cost money and uses up resources ,equipment and time that could be spent healing people. Lawyers must also be "regulated" . If they are willing to "access" a patient's condition and "access a cost to outcome" on a patient, then they certainly could do this with medical malpractice outcomes,,,access injuries ,,,what is blindness worth? loss of use of legs? This is not cruel,,,they already intend to make these judgments with our medical care...what is bypass worth on an 80 year old,,,,it is in the democratic bill.

    August 7, 2009 at 10:01 am |
  63. Joy

    Why do we need this bill for 'reform'. Why doesn't the government just give the people the option to buy healthcare that the government ALREADY offers; MediCare? Why do we need to create an entirely new system and have to raise taxes? A program already exists, it's already funded and regulated. Wouldn't that make the most financial sense? That's not the real issue though is it.

    So far they have not even discussed how much taxes would need to be raised to support this proposal and yes taxes will be raised. They have not discussed reducing ones ability to win outrageous lawsuits.

    Healthcare costs are incredibly expensive but that's because the few spoil it for the many. A new healthcare plan is not going to fix that unless those particular issues are addressed and in this bill they are not. Not all healthcare agencies are bad, not all hospitals and doctors are bad.

    August 7, 2009 at 10:00 am |
  64. ACinCincy

    Steve,

    What you are failing to realize is that if there is an el-cheapo government option available, most companies would probably opt to go that route rather than pay the employer-side premiums for private insurance.

    Then we will have NO choice, but to take the government option.

    It isn't as simple as "don't want it, don't take it".

    If Obama won't sign his own family up for it, why on earth should I?

    August 7, 2009 at 10:00 am |
  65. None Given

    How about when you report things to the insurance company....and the insurance company DOESN'T CARE!!!!

    Like the insurance co getting billed for 2 choppers, 2 chopper piolots, 2 chopper nurses, 2 incubators, 2 O2's, etc when, yes there were 2 babies, but it was a shared incubator one 1 chopper, with 1 pilot, 1 nurse, 1 incubator with 1 O2 tank!

    August 7, 2009 at 9:59 am |
  66. Gerald

    When all of the goverment signs up for the same care they are offering you and I then it will be time to talk. Until that happens there is little hope that the same people managing social security and medicare which are a total mess can manage health care. Remenber the democrats have controlled congress since 2006 , Hope is not a plan.

    August 7, 2009 at 9:58 am |
  67. Wayne

    Fraud also includes many health care vendors and the GPO's

    When Lab companies get fined 300+ million dollars you can bet they took a billion or more and don't want other things uncovered. The lawyers say it's to avoid litigation but we know what BS that is. They find work arounds like bundling and paying doctors for office space for blood draws which guarantees them all the business and volume.

    the GPO's claim to get hospitals and regions the best price and that they do for a few select expensive items then the rest sell at very high cost protecting some healthcare giants margins by squeezing other companies. These giants in the background limit the choices of vendors and bidding. If cherry picking was done and it can be done easily with technology then hospitals could reduce supply costs 20-50%.of existing contracts

    We need a walmart or someone with deep pockets and distribution to level the field and all the greasing.

    August 7, 2009 at 9:58 am |
  68. Dave

    Roland's comment: "the lack of incentive among private insurers to not care about fraud is even greater"

    I totally disagree with his assumption. I am employed as a fraud investigator with the largest health insurnace company in America (not Blue Cross/Blue Shield). We have a staff of literally hundreds of investigators and fraud analysts. We are currently in negotiations with other insurers to provide training to them in how to detect fraud and prevent claim payments to known fraudulent providers. So far this year, our company has saved over 430 million dollars by preventing claim payments to known fraudulent healthcare providers. The 430 million was and is used to reduce premiums.EVERY report of alleged fraudulent activity is taken very seriously.
    Part of my job is to notify other insurance companies when a provider is suspected of fraud. I recently contacted Medicare to report a provider (they were the primary payor, we were secondary). Their response: "we're too busy to worry about that, but thanks for calling".

    August 7, 2009 at 9:57 am |
  69. Todd

    Here's an idea. Rather than wholesales replacement of the current system, which WORKS for MOST Americans just fine, how about identifying the problems and FIXING them? Maybe, just maybe, that would allow, I dunno, medical costs to go down, insurance rates to go down, and more people to be covered. Sound like a plan? We KNOW from long experience how government plans are rife witrh fraud – remember the $600 hammers for the Pentagon? Anyone REALLY believe there will be less fraud with a government program? Fraud. Malpractice reform. Regulatory reform to streamline processes. Lots of things we CAN do, that everyone agrees SHOULD be done, but yet the liberals want to force feed us a government plan without even TRYING to fix the current one? I wonder why...

    August 7, 2009 at 9:57 am |
  70. mike

    i also love the fact that they're talking about taxing insurers now to pay for some of this reform.

    who pays that tax? not the insurers. they pass it onto policyholders.

    you know the ones that are making under $250k per year that Obama PROMISED he wouldn't tax as recently as last week.

    typical washington bait and switch that i would have HOPED would have CHANGED with this administration.

    same as usual. its one thing with most politicians but Obama came in on a platform of change and isn't changing anything. SAD.

    August 7, 2009 at 9:55 am |
  71. Erricz

    Sick that many of you think this is a Republican attack on the Democrats. Untrue, I like many of my Libertarian brethren, just don't want more government waste and fraud in a system that is currently rife with just those things. Not to mention the plethora of failed social programs currently and previously run by the government: did everyone conveniently forget that Social Security is a gov't run program about to get tanked into the ground? No, why would anyone bother to read about history so as not to repeat is so suddenly. Now the administration wants people reporting their fellow citizens for being AGAINST this health care "reform"? McCarthy-era scare tactics? Who is stooping to unimaginable levels now?

    August 7, 2009 at 9:54 am |
  72. DENNIS ARRAS

    as a former directtor of child support enforcement and fraud investigations, i can tell you that in the county where i worked, we investigated 455 cases for the department of Health and Human Services in 2008. 46% of those cases had fraud associated with them. we saved $350,000.00 in benefits not paid out illegally. we also recovered in excess of $30,000.00 from those we prosecuted. we began a fraud program in 1986 and have saved the state and the feds hundreds of thousands if not millions of dollars thru these investigations in food stamps, medicaid/medicare, daycare, etc.

    August 7, 2009 at 9:54 am |
  73. Trylon

    As I watched the movie SICKO in Flint, MI, I felt badly that Michael Moore did not have the time or means to compare the countries he used as examples of different healthcare systems for the prevalence or degreed of FRAUD perpetrated within those systems.

    If such a figure for a country can be achieved – with acceptable reliability and validity – the next step would be to correlate these national figures with a) murders per year, and b) death by gunshot. That would result in a table three colums wide and as deep as the number of countries compared, and compare national cultures.

    But that might be unnecesary. When the Medicare program became a reality, CBS investigative program, 60 Minutes, began investigating fraud – - and found that schemes to milk the system had been in planning before the ink was dry on the Presidential signature establishing the program.

    America's crooks live by the "can do" motto, they are second to none , but they live shorter lives than crooks of other nations.

    August 7, 2009 at 9:49 am |
  74. mike

    george from destin FL,

    Massachussets is considering that type of reform now and it has significant backing. I agree that would reduce the cost substantially but you'd have a hard time convincing doctor groups of that.

    August 7, 2009 at 9:49 am |
  75. DJ

    IN THE CASE OF THE WART REMOVAL IT'S OBVIOUS THAT THOSE
    IN BC WHO AUTHORIZED PAYMENT FOR THAT PROCEDURE WERE SLEEPING AT THE WHEEL. ANY GOOD COMPUTOR PROGRAM SHOULD HAVE FLAGGED IT AT ONCE.
    THE BC PROGRAM IS NOT FAILING,IT IS THOSE INEPT
    INDIVIDUALS THAT ADMINISTER IT. WE NEED TO FIX THE PROBLEM,NOT REPLACE THE OTHERWISE GOOD PROGRAM.

    August 7, 2009 at 9:49 am |
  76. mary

    Boy oh boy, aren't you Obama followers living under rocks. This government is playing Chicago politics, threatening, ignoring and lying to those of us who pay their fat paychecks. Did you ever think to ask why they don't want to be put on this plan but are pushing it on us? Have you ever heard the stories, one after another, about the horrible socialized health care in Canada and England? Why do they come here for their care? Of course only if they can afford it. They can't even pay out of pocket in their homeland to get treatment immediately for their illness/injuries. One more thing, go back to the last administration and let's ask ourselves how many times we endured the stories of the horrors of the Iraq war and now, even as it continues there and now Afghanistan, NOTHING. Could it be that the liberal media refuses to report on anything that will hurt this President? DOUBLE STANDARD and the American people are waking up and NOT going to take it anymore!!!!

    August 7, 2009 at 9:48 am |
  77. Michael

    What ever happened to common sense and taking a level of responsibility for ourselves. Of course we need reform. Fraud is rampant, overpricing for services is rampant, and worst of all BLAME IS RAMPANT. If our shining examples of government run programs are any hint to how the current system would be run then common sense tells us that putting them in charge is not the smart thing to do (especially as we all sit here and lay blame on the other, do you really think that will go away once the government has a plan in place, look at social security, I think not). I read a comment about grass roots and I strongly believe that that is the essence of America. We the grass roots have high levels of credit card debt yet truly show no restraint with our finances (see every shopping mall in America) and we want everything OUR WAY AND NOW, we don't save money, we don't prepare for disasters we just wait till they happen and put out our hand. I am a 8+ generation American raised by people with work ethic and pride. I don't need a handout, I need an opportunity and the rest will happen. Americans must look in the mirror and start there before any TRUE reform will take place. I am not in favor of a government run healthcare system, but make no mistake REFORM IS NEEDED.

    August 7, 2009 at 9:48 am |
  78. Satirist

    Why isnt anybody talking about GUNS!?!? untill this bill specifically guaratees that everyone gets to keep there guns it does not make any sense and should be tossed out!
    And what about tort reform? Trial lawyers and Dems and in bed and thats why fraud leads to high taxes in socialist health care.
    There is clearly no problem with health care because I have never seen one for myself, and all these stories are just made up and dont represent the real health care system. Fraud is right!
    Just look at Communist Canada. They pay 75% of their income to taxes. That is a FACT! and it all goes toward their socialist Health care where people wait in line for years to get signed up for a physician. Any reform of our system is just an excuss for Obama to make it like Canada, beacuse everyone know he's Kenyan, And Kenyan's love lines!
    Just say No (because having a conversation and asking questions requires thought)

    August 7, 2009 at 9:46 am |
  79. Gerald

    Why doesn't Congress let all of us join their insurance plan? I have read several articles about their plan and while we are at it we could join their retirement plan also. They do not pay social security taxes and therefore do not have to rely on SS as their retirement plan. No wonder they do what they want, as they want, when they want to these programs since they do not reap the benefits of their actions as we the common man does. I will glady join if invited as most other Americans would. Do we ever hear them talk about their insurance plans or worry about their Social Security – NO – they are taking care of – by us the taxpayer.

    August 7, 2009 at 9:46 am |
  80. John S.

    What about fraud from patients? I agree that there are fraudulent claims filed by healthcare entities, but why is all the blame put on them? As a medical office manager, I am confronted by patients asking us to "buff-up" the charts and change diagnosis codes after the fact to improve the reimbursement (which we would never do)...this is also fraud. Stop blaming the good people (99%) in the field who do the work and are the ones who are caring for the patient.

    August 7, 2009 at 9:44 am |
  81. Faith VA

    I have also reported insurance fraud to my insurance company and the state of Florida. I had discovered almost twenty prescription claims billed under my step-daughter ( who was 8 at the time) for drugs such as painkillers and anti-depressants as well as a third party claim for a visit to a hospital that my insurance had paid previously. Although the Attorney General's office investigated our claim, it was turned over to DCF to handle because it was considered public assistance fraud. In the end, DCF refused to prosecute, no reason given other than they didn't find any proof ( despite the existence of a fraudulent medicare card under my step-daughters name and social security number). However, it is obvious to my husband and I that they are NOT prosecuting because a:) they were paid by our insurance company for the money they shelled out and b:) why prosecute when your own employees can't do their job and allow people to fraudulently open accounts for people who don't qualify?

    There is rampant fraud in all government funded programs- Medicaid, Medicare, Welfare, Food Stamps- and everyone looks the other way. Sure they go after the big insurance companies and medical facilities to make an example of them, but who polices the actual programs to ensure that all steps are being taken to eliminate fraud committed by the recipient? Florida, for example, doesn't even do in person qualification meetings anymore- it is all done over the computer! If you don't believe, google it " Access Program".....

    I've personally had enough- its time someone has the courage to step forward and admit that this country is going to hell in a handbasket and we're sitting by allowing it to happen by being complacent and feeling sorry for people who work off the books and make more money than most.......

    August 7, 2009 at 9:43 am |
  82. Mark L.

    It basically boils down to "FACIST" GOP / Republicans vs. "SOCIALIST" Democrats, "RICH" vs. "POOR", "GREED / POWER HUNGER" vs. "SATISFACTION"...

    I would love to see what would happen if the US Government would COMPLETELY ELIMINATE other NECESSARY, WONDERFUL "SOCIALIZED" Programs such as Social Security and Medicare !! Even the FDIC – Does anyone have any idea how bad it was during the Herbert Hoover years prior to Social Security, Medicare, & the FDIC? In those days, when a bank folded, so did your life savings !! Thank Heaven for FDIC !!

    Yeah folks, let's strip all the eldery, retired people in this country of their Social Security and Medicare benefits and then let's see what happens !! That's what the GOP / Republicans want to do !! THERE WILL BE ANOTHER REVOLUTIONARY WAR !!

    Those of you who are opposed to healthcare reform legislation are either blinded by the GOP, GREEDY Because of ALL the Profits you are raking in via the Stock Market, or just plain IGNORANT !!

    August 7, 2009 at 9:42 am |
  83. Ursula

    Fraud may be one of the excuses for the ridiculous cost of health care in this country, but that in no way explains why a tablet of Tylenol doled out at the hospital is $10, while the pills you buy at Walgreens are pennies a piece. Walgreens also suffers from theft issues and fraud, and somehow they keep the cost of Tylenol down. I work in the medical industry and I am so sick of hearing these, in my opinion, criminal health insurance companies and drug companies complain that they can't possibly give the American consumer a break because otherwise they'd be going broke. I've seen the volume of garbage drug companies can afford to give away for free, I know the salaries of the slimy drug reps I deal with on a daily basis, and I know people who can't afford important medical care because their insurance won't cover enough of it. I think anyone who thinks any part of the current system is a good one is either a fool or a criminal.

    August 7, 2009 at 9:42 am |
  84. Lance

    For all of you who spout hatred toward healthcare companies- you are, for the most part, incredibly ill-informed.

    For example, Donna, I work for a health insurer, with the unit who helps people manage their diabetes. Health insurance loses money when your diabetes is uncontrolled, because that drives claims that drive costs that cost us business. Healthcare insurance companies are more successful when you are healthier, and have every incentive to help you get there.

    My compensation is actually impacted by whether our members become healthier. Not one US government employee, not even the Surgeon General, has their compensation based on how much they help people get healthy.

    Far from being the obstacle to reform, the Healthcare Insurance industry has been using our lobbyists to push for reform. Nobody sees the impacts of high costs or the uninsured more than us. No one sees the impact of healthcare fraud more than us. When the Democrats stalled on reform earlier this month, it was our lobbyists that kept it front and center.

    I know I will get flamed for standing up for Blue Cross- I do everytime on this page. But our profit margines are lower than most other industries. Healthcare insurance profit represents only about 1 1/2% of the cost in the system, and is less than half of the cost driven to you by Medicare cost-shifting. US health insurance companies pay millions of claims a day- we approve a million claims for everyone we deny.

    87% of our members are happy with the service we provide- how many government entities can claim that? Certainly not the president or congress.

    We were fighting to help people manage chronic disease, help people address lifestyle issues that affect cost, help to fight healthcare fraud and abuse, decades before Uncle Sam and Medicare showed any interest in these things.

    Please, stop villifying an industry that employs hundreds of thousands of dedicated professionals who work hard for you everyday and help us find the solutions that will allow us all affordable quality care.

    August 7, 2009 at 9:37 am |
  85. mike

    alan,

    sorry but you get no sympathy from me for trial lawyers. you are about as useless as insurers.

    also those that touted the 155% increase in profit from insurers are kind of silly. its because they were down so low.

    last year's profit margin (2%) look it up on fortune.com there is not this windfall profit they'd have us believe. its all smoke and mirrors.

    the actual dollar amount United made in profit i believe was 750 million. is it too much, YES.

    that amounts to about $20 per insured person per year. sorry that's not windfall and i don't know how you regulate that out and yet still have people that want to work in healthcare. maybe if you could you'd force them all to be non-profit. not sure you can do that though.

    what you need to do is regulate the system better. allow purchasing across state lines.

    August 7, 2009 at 9:36 am |
  86. Marc

    So, why would there ever be the assumption that government run health care or health insurance would not be susceptible to fraud? It's not like all the criminals would simply go away. Indeed, isn't our welfare system as well as medicare and medicaid already taken advantage of professionals and those that it is meant to service all the time anyway. I dare say yes. In fact, I dare say that a government health care or insurance system is probably MORE likely to be vulnerable to fraud simply because of the beauocratic way that the government works. Investigating and attacking fraud would probably be a "taxing" and highly ineffecient process just as 99% of all government run programs are already. Why should this be any different???

    August 7, 2009 at 9:36 am |
  87. Colin

    Unfortunately, people on both sides of this issue are confusing things and lumping things together that don't belong.

    Those that are against government control of your health care are NOT against reform. When you say they are, that is known as a "false dichotomy", look it up.

    Those, mostly politicians, that are trying to have the government run your health care are using a misleading "uninsured" number as the crisis, when it isn't, because the true number is only about 3% (but rising). The real problem is COST, not coverage. Coverage does NOT solve cost, cost DOES solve coverage.

    Please, America, take a minute to THINK about what you're getting us all into. Reform, YES! Government run, NO!

    August 7, 2009 at 9:36 am |
  88. Ellie

    I work hard to earn my insurance each week. If the president wants to come up with a public insurance, find a good way to pay for it that doesn't increase our taxes, fine. But don't force it on those of us who already have insurance. Give us the choice.

    August 7, 2009 at 9:35 am |
  89. Joe

    It's funny how people let their emotions rule them and completely overrun logical thought.

    First of all, I don't think that anyone would dispute the need for health reform. However, you'll be hard pressed to find a reasonable person who honestly believes that the Government can do a better job running a medical program when a majority of the officials creating these programs have little to no background in the subject matter being legislated (i.e. very few doctors in congress).

    No one disputes that Medicare and Medicaid are governent run programs, however, as our own President proclaims: "Medicare and Medicaid are broken, broke and unsustainable". I would like to know for one, how he reconciles this constantly repeated fact with the fact that the Health Care Reform act ADDS 18 million americans to the Medicaid system (by expanding the Medicaid eligibility to 300% of poverty level). Also, last time I checked, Medicaid is administered and funded mostly at the state level, and most states have already used a large chunk of their "stimulus" to plug the Medicaid shortfalls.

    While i am not opposed to a health reform per se I question the ability of a gov't entity to run such a system and don't advocate for a bigger gov't. Especially one who so frequently says one thing and then quietly does another (i.e. "those making less than $250,000/yr won't see taxes raised one dime" and yet the cigarette tax increase most heavily affects lower and middle income individuals who do the most smoking and a tax on your tax free insurance payments thru payroll soon to be a thing of the past in order to pay for a group of americans who are uninsured, despite the fact that a large number of them CHOOSE to be uninsured).

    August 7, 2009 at 9:35 am |
  90. Tim in VA

    "I for one don’t have health insurance because my employer can’t afford to provide it, so me and my family don’t have health insurance...I hyper-extended my knee last month...Weeks later I got a bill in the mail for $1500.00. I can’t afford to pay that."

    So I should be forced to pay it? You seem to think that anyone but you, whether it's your employer or the taxpayer is responsible for the costs of YOUR healthcare. That's why freedom is the big loser in this debate over whether employers or the taxpayers should fund healthcare, and that's why whatever we get from this debate is doomed to fail, just as other forms of communism did in the last century. Here's a radical idea: How about letting the customer pay his own bill instead of using governmental force to foist it on someone else?! Now if you'll excuse me, I have to go pay someone else's mortgage and subsidize his new car.

    August 7, 2009 at 9:35 am |
  91. m

    Ok, all you liberals who think the government can stop this fraud are once again uninformed. Medicaid has more fraud than anywhere else. Now that system is bankrupt and who runs it???? That's right the government is to be trusted, NOT!!!! Here's some great news, our wonderful government, under this bill, will go directly into your bank account and remove the funds to pay off your bill. Who the heck do they think they are??? And what about the illegals, where will the government go for those funds??? Oh, that'll be the taxpayers. Yes, you CNN junkies can now flag me!!!!

    August 7, 2009 at 9:34 am |
  92. One who knows

    For a licensed doctor to throw away his career for a few extra bucks (by doctor standards) should tell us something about the motivations of people pursuing this career. MDs are one of the most highly compensated professions in the country, if not the most highly compensated and yet it isn't enough. As we have found in corporate executives, the level of compensation does not yield the best results, it only draws greedy short-cited people to the profession.

    August 7, 2009 at 9:34 am |
  93. Stephen

    Fedup wrote at 8:46 am:
    "If you read the bill, it recuses itself of operating within the Constitution.

    pg 53 – SEC. 155. SEVERABILITY
    “If any provision of this Act, or any application of such provision to any person or circumstance, is held to be unconstitutional, the remainder of the provisions of this Act and the application of the provision to any other person or circumstance shall not be affected.

    So we should allow a bill that excuses itself from protecting people’s right to life, liberty and the pursuit of happiness?"

    It's amazing that you could read something and get the exact opposite of what the paragraph means. Read it again. What is stated is that if any part of the bill is considered to be unconstitutional, that part would be removed, but the whole bill does not have to be thrown out because one provision is struck down. This is actually fairly standard language for bills and even many business contracts.

    If you are going to fear-monger don't put the proof that you are a twit right in your own post.

    August 7, 2009 at 9:33 am |
  94. scott

    Just another case of big business fraud. If you think that's bad just wait until the ultimate big business (aka: the federal government) takes over.

    August 7, 2009 at 9:32 am |
  95. Stuart

    Perhaps the president and his minions would be best to direct congress in this effort. The supposed proposal now is over 1000pages and many of the congress and even the president have not read it all. It seems they just want anything without looking at what is included in this bill and the additional cost to people and business.
    The congressional budget office has already said that the savings dont come anywhere near to the new costs.
    Are all the present labor unions going to switch their members to this new public program? Will the members of congress and even the president put themeselves and their families on this program? Until the lead by example how would they dare expect anyone to go along with this?
    Does using Nazi and McCarthy area tatics of reporting people to the white house who disagree with this further their cause?
    If you want to improve things talk to the lawyers, medical liability insurers, hospitals, doctors and finally ordinary people not with agenda.
    The government right now cannot handle the cash for clunckers program what makes anyone think, that the government can handle 135million people on health insurance.

    August 7, 2009 at 9:32 am |
  96. Floyd Wilson

    To fix the health care system in America, you will have to "fix" the Department of Justice FIRST. For over 6 years I have tried with the help of my attorney to expose a common scheme used by the big hospital corporations to give "kickbacks" to their hospital based physicians. I've spoken to at least five active U. S. Attorney's and three "Special Agents" of the Department of Health and Human Services. To no avail.... I've been told that the fraud we've reported is "too complex, hard to investigate and the US Attorney's are not interested in this fraud." The people charged with these investigations are, in my estimation, just too lazy to look into the fraud committed by the large hospital corporations and possibly intimidated by their political power. Hospitals are willing to "skirt" the law and many doctors are more than willing to take these kickbacks. It is great to watch Americans come out to these "town hall meetings" and refuse to accept their Congressman's lame explainations of our ailing health care system. As a country, we are all frustrated by the fraud, abuse of power and out and out theft of our monies by our elected leaders and corporate executives. Thank you CNN for pointing out the fact that this $200 billion dollar PER YEAR theft from our healthcare system demands attention.

    August 7, 2009 at 9:31 am |
  97. Brad

    All Obama haters need to do their homework...nowhere does his health reform bill state that there will be healthcare for every american. The only people that will receive care are the ones that cannot afford health care. the idea is that this government involvement will drive down costs due to competition in the market. no totally government run health care. I agree that fraud is a major issue and it needs to be addressed, but Obama is the first president in decades to have addressed this issue. We need to start somewhere.

    so its not the end of the world, the sky is not falling. grow the hell up and stop whining. if my tax dollars are going to make sure a homeless man gets the medical attention he needs, then i'll sleep soundly.

    August 7, 2009 at 9:30 am |
  98. Michelle G

    Well, let’s just face facts here people. This healthcare plan is a BAD idea. First off, the fact that the president is trying to rush it through should be your first clue. Then you have the congressmen actually telling others not to bother reading it. When the details finally do get out to the public, people are going to be upset naturally. If you really think this is a good idea, go talk to a 50 year old Canadian. Luckily, Americans are finally starting to wake up and pay attention. Hopefully we are not to late.

    August 7, 2009 at 9:29 am |
  99. Jim

    As for those on this comment page that decry the disruption of the health care town halls, I agree with you about 25-33%, because:
    1) It is unfortunate that we can't have civil discourse. That's almost always going to produce a much better exchange of ideas than shouting and name-calling. Our inability to maintain civil discourse has made it impossible to really address/resolve many issues.
    2) As we should all be aware, these town halls are NOT designed to elicit voter input - they're designed as a media event for the congressmen to put out what they intend to do and act like they want to hear from their constituents (and be filmed doing so).
    3) Those disrupters are not all on one side of the debate. The Democrats have certainly marshalled their forces to chant, clap, or scream at all the appropriate points.
    4) Even if the disruptions were all one sided (against the Democratic proposals), it would be a case of "the chickens coming home to roost." Democrats/liberals have used screaming and name-calling to limit discussion and any diversity of thought or opinion for decades.

    August 7, 2009 at 9:29 am |
  100. George, Destin, FL

    As long as physicians and hospitals earn their money per each visit/procedure, there will be corruption and fraud.
    Pay doctors and hospitals a fixed yearly wage to see up to one patient every 30 minutes (turning down nobody) and 99% of the waste/corruption/fraud we are currently seeing will be eliminated. They will no longer have a financial incentive to bill as much as they can. Also, it will eliminate the wasteful billing process so doctors can have less overhead.

    August 7, 2009 at 9:27 am |
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