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August 7th, 2009
07:37 AM ET

Health care reform: forgetting fraud

[cnn-photo-caption image= http://i2.cdn.turner.com/cnn/2009/images/08/07/chernoff.fraud.cnn.art.jpg caption="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. Fred

    The Republican party has been hijacked by guys like Rush who have no concept of what "free market capitalism" is.

    Conservative economists do not subscribe to the view that government is the enemy. Conservative economists are wise enough to realize that regulation is often necessary to protect the citizenry from criminals. Policing Medicare fraud and abuse is no different than policing violent crimes. We do need to be protected from "bad people", whether they are hurting us or simply taking our money.

    I agree that the motivations of this "distorted laissez-faire" wing of the GOP are a bit frightening. Guys like Rush and Hannity seem to want to preserve a political and social order that is hospitable to criminals.

    Government is the enemy?

    Only if you are Bernie, Allan, Bernie II, Richard, or one of the countless petty criminals who parlay anti-government sentiment into ill-gotten millions.

    The rule of law must prevail, or we are all doomed.

    August 7, 2009 at 9:23 am |
  2. Tom N

    If I get my car repaired I get an estimate based on a book that says how it should take. I can probably go to 3 car repair places and it will be about the same (depending on their hourly rate of course). In other words – it is very "transparent". In health care it is a complete disaster.

    My son broke his arm in 2008 and the cost total $15,000 from about 8 different providers – some of which I could not even identify. There were charges of $20+ for a liter (1/4 gallon) of water. The above charges were only discounted by only ~15% based on the insurances contract!? As it happened on another persons property our insurance blamed the other party an only paid half. I am still fighting with the insurance and the other parties to get the rest paid.

    In 2009 he broke his other arm in a school/sport accident and of course we went to another hospital. Charges here came to over $17,000 from about 9 providers. Our NEW insurance discounted ~75% down to only ~25% of the original charges and than paid most of it while the schools "access insurance" paid the rest. It was quick and simple.

    Just looking at these too cases I can just shake my head. I have two folders full of paperwork and spend month handling the claim – but I am still not sure what was done and what all the invoices actually were.

    Back to the car – you normally sign an estimate and once you are done you sign the invoice, which states what was done. Why would it be so hard to do this in the health care industry? At least they should present the customer with one invoice (or at least summarized services provided) and let the customer sign off. To make sure that the actual customers signs (and not another doctor) a biometric system should be put in place to uniquely identify the actual visitor. It is easy to do and the insurance companies should be waiting in line to put the system and requirements in place – as it would safe them billions of dollars. Fraud is in every organization – not only in health care – but innovative technology can reduce it tremendously. View some educational info at http://www.fraudmitigation.com

    August 7, 2009 at 9:23 am |
  3. Jim

    The current proposals for health care lack several key things:
    1) Any discussion of Tort reform. Extravagent and frivolous lawsuits, outrageous jury awards, and the legal defense costs and defensive medicine costs (unnecessary tests, using the legally proscribed procedure whether needed or not, etc) are a HUGE driver in increasing health care costs. Yet, these huge drivers are willfully overlooked because:
    A) Many congressmen/senators are lawyers, made their fortunes that way, and don't want to hurt their buddy's lucrative livelihood, and
    B) Trial lawyers are a HUGE democratic constituency.

    2) Sufficient depth on fraud, as discussed
    3) Realistic cost analysis. I, for one, do NOT believe that this will ONLY cost $1.6 TRILLLLLLION over 10 years. Congress has downplayed the costs and overstated the largely-illusory savings. I suspect the real bill will be 50%-100% higher, meaning more taxes for us all.

    August 7, 2009 at 9:23 am |
  4. k

    why not allow private non-profits to sell coop insurance across state lines...that way the gov't is not involved (except for regulation), the taxpayers aren't on the hook, and there will be competition with the for profit enterprises. It's like the credit union movement vs. the bank.

    August 7, 2009 at 9:22 am |
  5. Michael Datskovsky

    First: I suggest to rename "Public option" to "NON-PROFIT OPTION", which is all it is about.
    Second: I suggest to implement "MEDICAL POLICE" to fight medical fraud.
    Third: It is time to open to american people, who actually stands between them and health care providers-It is insurance company!
    Every so called HMO insurance requers doctors to recieve PREAUTORISATION for a proposed by him medical treatment, which a) should be covered by person's insurance plan, and b) should be aprooved by insurance medical experts, (which are mostly nurses).
    Fourth: It is absolutely neccessary to open USA for foreign coutries medicine. Money for FDA to test them will tenfold be payed off to american people!

    August 7, 2009 at 9:22 am |
  6. Matt

    The current health care bill does nothing to bring down costs. Persuing fraud is one of the ways to help with rising costs. The others are meaning tort reform (health courts) so doctors don't have to practice defensive medicine and closing the loopholes on physician self referral for tests and usage of physician owned hospitals/centers (this ones huge, if your getting extra money for using a CT scanner you bought, how many more scans are you going to order? you do the math)

    August 7, 2009 at 9:20 am |
  7. Brian

    Reference was made to a 2 -tiered system. Don't you get it? There already is a 2-tiered system – those with insurance and those tens of millions who don't have any coverage at all, who are pushed to bankruptcy by hefty medical bills. Do you really enjoy a healthcare system where the Insurance companies dictate whether or not they are going to pay for a life-saving treatment, and that is only after you pay your healthy deductible?
    Get real, Folks! The system IS GOOD – NOT GREAT. It needs Healthcare Reform.

    August 7, 2009 at 9:20 am |
  8. Bruce

    I might be wrong but I think that too many people want something for nothing out there, and they want something from the government now. Remember now that the government wouldn't have any money if it wasn't for the working people. Quit trying to mess over the working people.
    We have plans in place but they all have loopholes in them that need to be patched. I progressed through several jobs until I finally landed one that had good health insurance. The key here is that I progressed and didn't stay stagnant. I just don't believe that this bill will help out in the long run. I think that it will just cause the taxpayers to pay more into a system that takes care of illegals and people that just don't want to work. I know that there are a few people out there that try hard and are just having some bad luck but that is the minority.

    August 7, 2009 at 9:19 am |
  9. Chris

    "This is why we need healthcare reform." We do, but I think part of the point of this article is that healthcare "reform" being proposed will do little to address the fraud which so often occurs with government programs such as Medicare or Medicaid. If anything, a larger public plan, administered by officials who feel free to spend taxpayer money, will do little to ensure that the claims are not fraudulent.

    August 7, 2009 at 9:18 am |
  10. Chas

    Everything the government touches invites fraud. But there is one type of fraud that government won't do anything about. That is malpractice lawsuits. One particular political party will not do anything to anger the lawyers. Take a guess.

    August 7, 2009 at 9:17 am |
  11. Ingrid

    We have great insurance. Both of us needed chiropractic care after we fell on ice last winter. Since we moved we went to a new chiro. Like most people we didnt really look at what we were charged but when we did we were shocked and angered. Normally we pay $50-$70 per treatment, but she was charging us over $200, or the maximum allowed under our insurance. She was double billing, and billing for services she didnt perform. My husband contacted our insurance. I wonder if they will do anything? Why should they if all the private insurance companies have to do is pass the fraud along to the insured. OTOH, medicare (run by the gov) is notorious for prosecuting and jailing those committing fraud. Maybe that is one reason medicare is so cost effective compared to private insurance.
    BTW, I worked in Canada in the early 70s, covered by the national health care and absolutely loved it. Those trashing Canadian health care are lying.
    How many people know how long can they be sick before they get fired and lose their insurance?

    August 7, 2009 at 9:15 am |
  12. Ric

    I have great insurance and have all my working life. Why would I want the government to tell me when I can go see a doctor and when??? That makes no sense. I'm not a rich person. I'm barley middle class. I also am a registered Dem since 1987 when I turned 18. What gives with my party??? I loved Clinton, Didn't care too much for Bush but Obama scares me.

    August 7, 2009 at 9:15 am |
  13. Mark L.

    Carl – First, I would rather have a Hammer and a Sickle on my Flag than a SWASTIKA, which is precisely the direction the GOP / Republicans would love to take this nation !! Secondly, you stated, "At least when I pay my health care insurance premium, I get something in return." REALLY? You actually get something in Return? Like what? Have you ever been diagnosed with cancer? heart disease? asthma? multiple sclerosis? alzheimer's? I would like to witness what your wonderful 'privatized' insurance company will do for you then !! Do you know the answer? You want me to tell you what they'll do? They'll tell you, "Sorry sir, the treatment plan for your disease is not covered..." WAKE UP AMERICA, JUST WAKE UP !!

    August 7, 2009 at 9:14 am |
  14. D

    Let's fix the problems causing health care to go up. Health Insurance companies still have to pay the high costs of health care, so if the problems that are causing health care prices to go up are not addressed, then provided a public health care option is going to do nothing. Notice how Steve went to the ER for a hyperextended knee. What?!? Come on people, the ER is for serious injuries that cannot wait, not for minor cuts and pulled muscles (or hyperextended knees). There was $1500 dollars that Steve has to address now where is could have be closer to $80 to see a nurse practitioner. People abuse and doctors abuse the system and everyone else has to pay. If you smoke or overeat, shouldn't you have to pay more for insurance? I think so. Why should I have to pay the same amount as a person who has no interest in taking care of their body? Will the government do anything about that? Nope, everyone will have to pay the same. That is not fair and I will not stand for it. I already pay enough taxes to people who abuse the system. Let me set this straight, I have no problems paying taxes to help people who real need it, but it angers me when I see people abuse that tax money that I help provide for them. Health care is such a big issue because it deals with people's well being and because of that, it is the easier to fraud and manipulate. For profit health insurance companies are going to be much stronger and well suited to defend against those attacks. Plus, health insurance companies are not just the high up people making big money. Alot of hard working Americans work for these companies. What happens to all those jobs when the government takes over? And that WILL happen if a public option is created. The government WILL make sure that happens. More people on the street and more people to cover health care costs on. The unemployment rate is already unacceptable. It is not worth putting all our eggs in one basket. Why is it such a hard concept to pass little parts at a time and make sure each part works? Why must we try to push through such a HUGE bill all at once? I don't understand it. That is project management 101!

    August 7, 2009 at 9:14 am |
  15. Christian

    I think the heart of the matter is the government does not want to get its hands dirty and solve any of these problems. They simply want to either take over, or provide a huge competitive block to private insurance, neither of which solve the problem. They simply allow government to do what insurance companies are doing, but in a way that is unfair to private business.
    Let's not be so quick to assume all insurance companies and doctors are fradulent. The same can be said for any industry.

    August 7, 2009 at 9:14 am |
  16. Lans

    I think most people just want to know they'll have affordable health care and have freedom in choice of doctors, etc. However, I think most Americans are being misled on "socialized medicine". It DOES NOT have to mean government control of the health care system. It does mean health care will be NON-PROFIT... doctors will still be highly paid etc.

    What is wrong with non-profit health care? The problem with the current system IS the for PROFIT component. The whole point of a for profit company is to increase profit each year and is NOT to make you all better/healthier (that is really just a byproduct).

    How does a hospital make more money? Treat more patients, sell more expensive options, etc.

    How does an insurance company make more money? Increase premiums and deny claims. Unlike life/home/car/etc insurance, most people (except maybe for say the young "Invincibles") can't say no to health insurance.

    If you really want real health care reform, stop being afraid of "socialized medicine" and start yelling "non-profit health care system". While you are at it, demand end to fee for service. Doctors still can be highly compensated with a good base salary and a bonus system based on how many satisfied patients they treated. A salary would prevent this kind of fraud at least...

    August 7, 2009 at 9:14 am |
  17. food for thought

    Why isn't anyone talking about lawyers? Maybe because Washington is full of them and it would be against their interests to limit lawsuits? Take away the monetary incentive and punitive punishments for lawyers and doctors. Then cases that have merit will be prosecuted and pursued. Why can't lawyers have a "bundled" rate as well? When I have the construction guy work on my house, I don't ask " how much do you pay by the hour". I ask "how much will it be to fix the sink". Doctors, lawyers, everyone should have a" bundled rate".

    August 7, 2009 at 9:13 am |
  18. mike

    what we need in this country is simple.

    REGULATION OF INSURERS.

    forget about setting up a trillion dollar government run plan. set up the co-ops without federal backing.

    many states have regulations that require insurers to pay a set percentage of their premiums in claims so that they can't make egregious profits. My state of NJ is 75%. It should be 85% ACROSS the country. then we'll see profits shrink.

    plus everyone should be required to be insured. car insurance costs went down when this was made law. People shouldn't be able to game the system to their benefit.

    how many people out there now don't have insurance because they've just had the light bulb go on in this debate by finding out that they can't be turned away from the ER when they go.

    Well let me save $300 a month in premium and it i get sick they need to take care of me is their rationale. Sorry its wrong. We all should pay and we all should be responsible.

    August 7, 2009 at 9:13 am |
  19. Jeff

    I am a physician (salaried, working for a large HMO). There IS fraud; but there is also tremendous waste in the system even as it stands. This is due largely to defensive medicine, inefficiencies of the practitioners themselves, and, I believe most of all, to a proliferation of middle management in the health care system that is meant to be "supervisory" but in effect constitutes a self-sustaining bureaucracy of people with no interest in patients and no knowledge of medicine making hospital, corporate, and government policy decisions. Obamacare will make ALL these things worse.

    Tort reform is an absolute must. But, we also need to make medicine focus on patients and their physicians again, and on the business of health care rather than on the health care business. There are plenty of us who will work for flat salaries, profit motive removed, if we can practice medicine, rather than being data entry clerks and scapegoats for bad managerial practice.

    August 7, 2009 at 9:12 am |
  20. alan

    Now the trial lawyers are the boogie men and women right? Last I checked they have to eat and live and provide for their families just like you and I. Now they are friends of this Administration.
    Let's see who were the friends of Bush Adm., oil companies, health companies, Blackwater, Enron, Saudi empire, and on and on!

    August 7, 2009 at 9:12 am |
  21. Milt Kirschner

    Hey Obama. Stay out of my housing, and out of my doctors office.
    Use my taxes to pave the roads, repair the bridges but STAY OUT OF MY PERSONAL BUSINESS.
    My money is mine to spend as I wish.

    Read every word of the so-called-health-care-reform bill and listen to the people who pay your salary rather than to the lazy loud mouth bums who expect others to carry their load.

    And by the way, you will never stop fraud, it is part of some humans makeup.

    August 7, 2009 at 9:12 am |
  22. shawn

    The insurance companies love articles like this,it makes them look like victims and while it does happen- doctor/hospital fraud, how about fraud from the insurance co-if the goverment really wants to reform health care, start by regulating the INSURNACE COMPANIES. The last thing we all need is the govt's say in our health care, the insurance companies already dictate how doctors should treat partients especially BCBS. Why are insurnace co's telling Dr how to treat patients by limiting what procedures they will pay for? How much profit did the health care insurnace companies make last year?!!!

    August 7, 2009 at 9:10 am |
  23. Bob

    If you are so naive to think there will be less fraud when the govt oversees healthcare then you should bow out of this debate. Also I find it very irresponsible to throw around statistics without a source. Who exactly says 1 in 3 claims are fraudulent???

    August 7, 2009 at 9:09 am |
  24. mike

    i'd love to see ACTUAL statistics as to how many claims from insurers get denied.

    to me its kind of like the top news stories on the 11pm news.

    yes murder gets the highlights but 99% of people aren't committing murder.

    Is murder still wrong, absolutely yes. Doesn't mean that everyone's doing it.

    Which is it? Are insures paying too much (ie costs going up) or are they denying everything?

    If they were denying everything there'd be no costs.

    August 7, 2009 at 9:08 am |
  25. Commonsense

    This comment is directed to "Steve" who tells us we don't have to sign up for government health insurance if we don't want it. How do you think the government is going to pay for this plan? The answer is THE TAXPAYERS! The same taxpayers that are paying for Social Security, Medicare, the salaries of all the government workers and all the other programs the federal government comes up with. The TAXPAYERS already know the fiasco MEDICARE is and has been for decades with all the fraud and abuse and we don't want another program SHOVED DOWN OUR THROATS! If you think your 1500.00 knee injury is too much money, just wait until you get the tax bill to pay for government health insurance. Just ask yourself, if this insurance they're pushing is so good, why don't the Congressmen and women sign up for it for themselves and their families? Believe me, they won't.

    August 7, 2009 at 9:08 am |
  26. Rob

    Our government can't keep themselves honest and yet they want to try to fix health care? How many of the Obama appointees have had to step away because they themselves were found to have not paid taxes, while the rest of the hard working Americans pay their taxes? I should not have to pay for health care for someone who is fully capable of working, but is too lazy to get a job. I work for a living, and am provided with insurance through my company. Having our government try to fix this is like repairing a hole in your boat with the fish net...

    August 7, 2009 at 9:07 am |
  27. Nick

    First of all, I wouldn't consider a podiatrist a physician. Secondly, one dishonest health care provider does not represent the entire health care field. Finally, how will reform solve this problem? There will always be thieves and cheats in EVERY profession! No getting around it.

    August 7, 2009 at 9:06 am |
  28. Donna

    And to that Fat sean who says shrug, and doesnt have a problem for his Insurance, I say, I dont care how rich you are because healthcare and insurance companies feed off your money. they love the rich, so the fatter you get, the more they care for your diabetes, heartcare, high cholesterol, arthreosclerosis, ect,ect,ect, until you drop dead. it's like drug addicts, the dealers use them until there is nothing left to take, usually deasth is the reason! you will find a nice crowd of people around you , but it's not for you , it's for money.

    August 7, 2009 at 9:06 am |
  29. Robin in SC

    I'm a certified health care compliance officer and have worked in health care administration for 17 years. I've seen facilities closed and docs licensed pulled due to Medicare fraud. Fraud is rampant and must be addressed, but the other contributor is illegal immigration. Tort reform should be left to the states and many, if not most, have passed tort reform laws in recent years. Illegal immigrants drain our health care system of more dollars than anyone knows. Illegals crowd our ERs and are the reason those of us with insurance or money in our pockets to pay are sitting in ERs for endless hours waiting. We can take care of our own, but not the world.

    August 7, 2009 at 9:05 am |
  30. m

    Wake up people! I am a physician, I don't commit fraud.But if this garbage single payer system goes through, we are in for a world of hurt. Physicians will no longer be able to practice if they don't get paid-think 200K debt at the end of medical school, we won't have quality health care or doctors after a few years. Tell them to get a tighter clamp on fraud- because a podiatrist (not an MD) defrauded blue cross of a couple hundred dollars does not make a reason to pass a trillion dollar senseless bill for obama's socialist agenda that will bankrupt america. And here's another thing-all the uninsured people already do get coverage in the form of emergency medicaid and doctors get paid literally pennies on the hundreds of dollars of charges and are still liable for anything that goes wrong. How about tort reform- why haven't we heard about that- probably because obama's left hand is in the pockets of the lawyers.

    August 7, 2009 at 9:04 am |
  31. Ed C

    Fraud control is little discussed BUT medical insurance and the associated legal reforms get no real discussion let alone anyone find any legislation, hearings on the tort reform matters?

    August 7, 2009 at 9:04 am |
  32. Gus

    I bet this doctor was a staunch Republican and opposed to health care reform. Now all the seniors on Medicare will be out yekking and screaming about the helth care reform.

    August 7, 2009 at 9:03 am |
  33. Vicky Bevis

    BTW, I forgot to mention that most people don't know that private insurance companies contract with hospitals/surgi-centers w/o many times the bennies of a lowest bidder situation. Could ur HR dept. in ur company b " on the take?" Does "kickbacks" ring a bell? Also, not known, but some meds. r literally only 1 molecule different from other, newer, competing drugs. I had a drug rep. admit this to me.

    Can reform in health care work? Well, just look at what happened after AARP got on their backs about Medicare prescription bennies: COMPETITION in the drug companies & we ALL now have $4 scripts at many places including even our local, small, privately-run pharmacy for many of the most commonly prescribed meds. I switched to one after hubby retired since the one I was on was much more expensive. Dr. wasn't too sure the cheapo would work but surpirse-LIKE A DREAM! Can u say: "$4 a month vs. $63?"

    Tort reform would help also, but since most lawyers r Dems., ain't gonna happen. A number of yrs ago, in Pa., we ALMOST lost all our OB/GYN's due to stratospheric practice insurance. Funny how that got solved quickly when they began leaving the State in droves. Some came back, but others had had enough of Pa.

    Basically, I KNEW that this crises was coming for over 20 yrs. Remember how HMO's were going to "solve" the problem back in the 80's? It just slowed things down a bit. Wish I had a solution as it is affecting good, nursing care along with medical practioners' plan of care.

    August 7, 2009 at 9:03 am |
  34. Sharon Chambliss

    I am no expert on this health care issue. From what I hear it sounds like some people have healthcare and some don't. It also sounds like that when the people that don't have coverage need medical attention they go to the ER and the bills don't get paid. That seems to drive the cost of medical care up for those who have coverage. It seems to me that providing some type of coverage for everyone would be the right thing to do and would help to drive medical costs down. Our President told us when he was campaigning that he could not do it alone. I both believe and trust that he knows what he is doing, but he needs our help. Call your congressman or representative and tell them you are FOR getting the healthcare bill passed NOW!!!!! Getting him elected is one thing, backing him up is A WHOLE OTHER JOB!! Let's get busy...

    August 7, 2009 at 9:03 am |
  35. DaveDayton

    How about this for an idea:
    Let the insurance companies and hospitals not only perform services but also let them govern themselves completely? Let the hospitals and doctors govern themselves.

    Absurd.

    How about this for an idea:
    Let the government perform services and govern themselves completely?

    Absurd.

    There is a reason the government is called GOVERNment – to govern. Not perform services. How well would the government stand up to their own Sarbanes-Oxley act were it applied to themselves? Separation of duties EPIC FAIL would be the grade.

    August 7, 2009 at 9:03 am |
  36. Mark L.

    Democratic Healthcare Reform = 'Socialized' Healthcare (ex.: Medicaid, Medicare, etc.)

    GOP / Republican Healthcare Reform – 'Facist' Healthcare (ex.: privatized insurance & stockholders getting RICHER & RICHER at the lower & middle class workers' expense. Bottom Line – The GOP / Republicans would put a REAL BIG SMILE on Adolf Hitler's / Benito Mussolini's / Joseph Stalin's / Nikita Kruschev's face[s].)

    August 7, 2009 at 9:02 am |
  37. john in ga

    We need Healthcare reform. United Healthcare reported a 155% increase in profits this quarter in a horrible economy. There business plan is to deny until they either break the patient or they can't deny anymore. Actual EX: the brain tumor isn't life threatening yet so we can't pay for it. And before someone says it we have to wait in our current system and we more for people without insurance now than we will in a public plan. Also we are number 2 in medical spending and number 37 in quality of care. Open you eyes. Also, check the huffington post there is a interview with one of major organizers who is staging the much covered protest. CNN time to do some report for once.

    August 7, 2009 at 9:00 am |
  38. spaceman

    lots of people on here cant understand how someone would be against this health reform. first off its a sham, you can not have real cost control in health care without tort reform. the dems are protecting trial lawyers and there is no way around that. second, it doest pass the smell tesst. you dont spend a trillion dollars in order to "save" money. you cant require small businesses to cover their employees without losing jobs. these 3 things do not pass the smell test and they make this so called health care reform stink.

    August 7, 2009 at 8:59 am |
  39. Petre

    It's great that the insurance companies are working to protect themselves from being ripped off. However, these are the same health insurance companies that Deny, Delay, Decrease and Distort (the 'D's that these companies live by) the legitmate claims of their premium paying customers. These companies over bill, double bill and under pay. If there "D's" are not challenged, the premium paying customer is the victim of a rip off fraud. If these health care insurance companies don't like being ripped off, then imagine how us customers feel when you make it a standard operating procedure to rip us off.

    August 7, 2009 at 8:59 am |
  40. Gerald

    I'm just worried about the amount of money that is being spent on insurance. I agree with all the comments about fraud. My dad (85) was told he had liver cancer and was treated for several years as an outpatient. It took him 15 minutes to get to his "treatment room" (nurse lounge) get his shot and return to his car. He was charged for a hospital room (which he never saw) and was given 2 asprins to control the fever which he got from the medicine. He was charged more for 2 asprins than he could have bought a whole bottle at the pharmacy. I called Medicare and reported the "fraud" (hospital room and astounding price for the asprin) and was told "that falls within the guidline for medicare charges" – the government can get away with this? Also why is it someone on medicare and I can go to the same doctor, have the same treatment, and be charged different prices. The medicare patient pays 600 dollars(Medicare pays) and I get billed the full amount ($2000.00). The doctor writes off the balance for the medicare patient (he takes consignment) and between me and my insurance company we pay the whole amount. My wife works in the insurance office for a doctor so I know this happens.

    August 7, 2009 at 8:58 am |
  41. Calvin

    I reported a case of medical equipment fraud to the national, state, and insurance company's hotlines and on-line forms. At all three informed me that they would not be pursuing the issue (worth thousands of dollars).

    My insurance company continues to pay and I continue to receive bills for hundreds of dollars per month for a $540 wheelchair that I returned after paying more than $1,500 to rent it.

    The equipment provider originally charged both of my insurance companies the full rate and billed me $145/mo. When I lost my job and only had one insurance company, the provider started the billing over from scratch. When I asked they said that they do that because the new insurance company doesn't know what's already been paid.

    Now, they're continuing to bill my insurance company and me for a chair that has been returned. I have to pay them or risk a negative entry on my credit report and none of the agencies I've contacted will take any action.

    Is this a problem? I'd have to say "yes."

    August 7, 2009 at 8:56 am |
  42. Susan

    Only the rich ones and their doctors, the insurance companies, and the people who are into the illegal business of so-called health care (Miami the capital of this type of practice) would not want a national health care for all.

    My family (including my children) was not and is still not able to go to the doctor since (me) the bread winner got sick and unable to work. Medicare covers 80% of my cost, but I am not able to pay the 20% because the clinics rack up the bills with items that I have not had in treatment. I sent a complaint to the Medicare people, but it seems as if that went on deaf ears, for the Sunrise Medical Clinic in Pembroke Pines and their therapy department is still functioning normally.

    There are thieves in our system who steels from the poor to make themselves rich; this goes on in the school system, the health care system, the police system, and everywhere around you (come to Miami to see how much of this type of practice is going on. Come see the illegals flocking here and getting all the benefits that born Americans cannot even dream of getting. Come see the corruption at Florida International University, Miami-Dade College, and the Dade-County School Board – the minority of Hispanics getting all the jobs, the students coming in from Cuba and other Latin countries illegally (yesterday) and getting all the help they need from their people. They do not have to speak English or be qualified, but are getting all they need without working a day here. All other minorities are ignored, cast aside, not given jobs and eventually will have to leave the newly formed Cuba.

    SOMETHING NEEDS TO BE DONE TO STOP THESE ILLEGAL ACTS. THE IMMIGRATION SHOULD BE MONITORED MORE STRINGENTLY.

    August 7, 2009 at 8:56 am |
  43. Brian Macker

    The third party payer system in the form of health insurance paying for first dime, and Medicaid and Medicare are all due to government intrusion into the markets. Funny how fraud in a government run and warped system is interpreted as proof that we need to turn over our medical care to a governmental central planning committee. Some people are so ignorant of economics.

    August 7, 2009 at 8:55 am |
  44. mike

    steve pearlstein has a great article in the washington post today.

    tort reform would save in many people's estimation $200 billion.

    but that would hurt the administration's co-horts in the trial lawyers association.

    August 7, 2009 at 8:55 am |
  45. Mark L.

    Bottom Line – The GOP would rather have a facist-style healthcare system that benefits the privatized insurance companies and stockholders rather than a public option that would benefit all. I seriously have to laugh at the sweet, little ol' lady who was on TV yesterday adamantly opposed to healthcare reform because of it being labeled 'socialized' medicine and how it may potentially affect her Medicare. This was simply HILARIOUS !! Just what in the heck do you think Medicare is, for cryin' out loud? The answer...SOCIALIZED Medical Care !!

    For those of you whom are opposed to healthcare reform legislation – I only hope the reality sets in for all of you one day if heaven-forbid you are diagnosed with cancer, heart disease, asthma, multiple sclerosis, etc. You will then WAKE UP and realize the mistakes you made pleading with the facist GOP / Republicans to tear down healthcare reform legislation.

    Oh, I want my America, my sweet, sweet America back too !! The GREAT America that we once had under the likes of former Presidents Franklin Delano Roosevelt, John Fitzgerald Kennedy, Lyndon Baines Johnson, William Jefferson Clinton, and our current exemplary President Barack Hussein Obama !!

    The Republicans need to go SIT ON AN EGG !!

    August 7, 2009 at 8:54 am |
  46. Smart Guy

    The insurance companies are not good, and we should work to fix that problem. However, using the government as the only provider is bad. I say only provider because they will undercut normal insurance costs and everyone will adopt it. When this happens (and it will because nobody can compete with free) several things will occur: 1. Medical care will become commoditized and stagnate at the current state of affairs. 2. Pharmaceutical companies will go out of business and not create new drugs. 3. The cost of medical coverage will skyrocket and will either be paid for by much higher taxes or inflation. One thing everyone on here is forgetting is that medical care is also more expensive because it is BETTER than it used to be. Would you rather get treatment for cancer now or 10 years ago or 20 years ago? Answer that question. I bet if you get the treatment from 10 or 20 years ago, it isn't nearly as expensive as the current treatment. Consider antibiotics. How expensive is penicillin now? Not very but it also isn't very effective for a lot of stuff. Well, take a govt system and you will see very little new developments in the medical world from then on unless it is done in a country that has free markets.

    August 7, 2009 at 8:54 am |
  47. JAMES DUCKWORTH SLC UTAH

    but they let all of them keep their licences
    isn't that funny ???
    i wonder how much they make under the table

    August 7, 2009 at 8:54 am |
  48. Christian

    Reading through the comments I see someone stating protesting is "Anti-American" activity. This couldn't be more incorrect. The voter communicating with their elected official is what should be happening. This is in line with the republicans stating protesting war is anti-American.
    The fact remains, fraud in current government programs is so expensive, the order of magnitude with a total government system will be in the trillions of dollars. With the debt we are carrying, the country cannot afford this. We need to address fraud and tort reform (loser pays). Many countries with a national health program have caps on tort claims. Unless this is address, we are not truely talking about medical reform at all. Also, why do employers have to provide coverage? Why did the responsibility for our own well being become the responsibility of the employer? How much would cost drop if individuals purchased their own insurance (even across state lines) and were able to do it a la carte (why do I as a male pay for child birth)?

    August 7, 2009 at 8:53 am |
  49. Insured

    I am one the "lucky ones" I have heath insurance. I pay about $50 a month for the premium, nice right!. The fact is that in the first 3 months of this years I have paid about $2500 out of pocket. Most of this is for minor things, colds, flu twisted ankles. A public option would make it more affordable. I HATE that I have to worry about taking my children to the doctor because I may not be able to afford it, when I have insurance.

    August 7, 2009 at 8:53 am |
  50. mel

    what is fear of reform,ceos of insurance co.not making 100 million dollar pay per year

    August 7, 2009 at 8:51 am |
  51. D. Tree

    Well if the government DID try to do something about Doctors defrauding insurance companies, will the GOP say they are "getting between you and your doctor?"

    August 7, 2009 at 8:50 am |
  52. Donna

    This is such a corrupted country! I worked in healthcare for over 20 years, and I could see all the crap going on. It's healthcare, and Insurance companies that keep it going. the fraud that goes on needs to stop, and needs to stop NOW! thats why president obamas healthcare reform is having a tough time getting through to pass. all these greedy, corrupted idiots are taking away from us to cater to themselves, and I am sick and tired of these people taking, taking and taking! sure they like their healthcare, because it's so easy to steal from !! I hope they change this stupid american healthcare, or I feel like moving to paris,france for my golden years !! I'm beginning to dislike america, it's so out of hand with greediness, and drugs !! and nobody cares about much of anything anymore !

    August 7, 2009 at 8:50 am |
  53. Micah

    As a former employee of a government contractor for Medicare, there is billions in dollars of fraud in the government program. Ask the someone at CMS if they have ever heard of the Russian Mafia's durable medical goods schemes in Florida. I will believe a government run heathcare system will work when Medicare is fixed.

    August 7, 2009 at 8:50 am |
  54. Mike

    The Democratic leadership has had to spend a great deal of money to keep our economy and markets from totally collapsing. (don't forget the TARP was created by a Republican administration. ) All this talk about the democrats spending tons of money needlessly is ridicules. We are sitting here today able to discuss a subject like health care because the economy as a whole is much more stable the it was six months ago.

    Health care needs to be reformed and Obama has taken the harder road by choosing to make the changes now vs later. The Republican and the health care lobby only care about their own selfish interests. The people showing up to scream down rational discussions going on are just tools of the lobbyist and the far right mentality of selfishness.

    All families and individuals that work hard should have the ability access health care at an affordable fee period.

    August 7, 2009 at 8:49 am |
  55. robert

    This morning report on Fraud is a wake up call on how little the media (including CNN) has done to provide real facts. To assume that reducing fraud will be significant enough to improve health care is a misconception. How about health care equipment providers overcharging (10 times the actual cost) on items such as wheel chairs. Health care fraud is a tip of the ice berg. We need a comprehensive health care reform including public option.

    August 7, 2009 at 8:49 am |
  56. B

    Just make all health care providers give an estimate of billing prior to getting the patient to authorize treatment. I fully believe that IF any American could actually SEE what it will cost before hand they would make better decisions about their care. Obviously immediate care for a heart attach (or something of that nature) would not be addressed that way, but for the most part those are not the types of claims you see fraud on. Its usually something just a little extra. Another minor procedure combined with the one that was actually done. Or the more blatant, billing Medicare for scooters of people that have not gotten them. Duh.
    As far as those "triggers" in the billing code to prevent things like invalid payments to dead doctors, or for dead patients, nearly every insurance carrier has them built in now. For the most part they do not stop a claim in its tracks, instead it sends a report so that someone at the carrier can then send an EOB saying it is denied for X reason.

    August 7, 2009 at 8:49 am |
  57. Bill

    Yet another article that pushes healthcare reform that is totally one-sided. MOST providers, including doctors and hospitals, would never intentionally submit fraudulent claims. However, they are penalized everyday, adding up to annual penalties in the millions in some cases. I would make the case that the government and some commercial insurers are OVER-vigilant about coding fraud. The penalize the system up to 3 times the amount of the false claim, even though the claim could be undercoded, meaning the provider charged less than they should have.

    This article doesn't mention that. CNN chooses once again to simply advocate FOR reform in any way possible. You know there is more to this story Mr. Chernoff...let America know about Medicare's new RAC program. Let them know how much more providers are penalized for ridiculous reasons such as undercoding and misusing a certain modifier. That's the true injustice.

    August 7, 2009 at 8:49 am |
  58. Dick

    Americans don't want to have open discussion screamed down by hired fanatics and there is a growing movement of health care reform protesters meeting these hired nuts when their buses roll into town. We will have our own crowd meeting them today in the small town I live in. This movement, our side, is real grass roots. America wants health care reform so the numbers are on our side.

    August 7, 2009 at 8:49 am |
  59. alan jones

    These people are killing me with laying all this crap at the President's doorstep. Where were you people to storm Town hall meeting the last 8 years? Oh I forgot lapping up every lie that spewed out of bush and Cheney's mouth. if we just had the wasted cash on this two failed and ill-adviced wars we could insure every citizen! Malpractice is every patient's right to pursue if they have been botched up by a doctor, nut.

    August 7, 2009 at 8:48 am |
  60. vicky Bevis

    ANY kinda health care is a Charlie Foxtrot. When my husband retired in Jan. 08, his health care "retired" with him. But, not to worry as he gets S.S. which, pays better than the last several PRIVATE plans he had. My "rellies" in Australia have a socialized medical system & none of them are ging bankrupct. Funny how THAT system is never mentioned nor N. Zealand's.

    So, I have no medical insurance since I was turned down when I gave several companies my medical history which ONLY includes mild hypertension which is TOTALLY controlled with meds. Get this: I listed a hysterectomy I had 22 YEARS ago for non-cancerous reasons & they even listed THAT on my rejection form. Basically, they put EVERY sugery-2 c-sections included-that I had EVER had as a reason they didn't want my $ even tho I was just applying for catastrophic insurance.

    Personally, as a retired nurse, I hope they ALL "crash & burn."

    August 7, 2009 at 8:47 am |
  61. Tim

    How can they talk about health care reform when they haven't even mentioned tort reform?

    August 7, 2009 at 8:47 am |
  62. mike

    roland,

    i'm sorry but you're wrong. Private insurance DOES have incentive to investigate fraud. they're in a competitive situation with other insurers. if they don't investigate fraud they will lose market share to another carrier.

    government has no competition in medicare. that is why there's no incentive to investigate fraud.

    August 7, 2009 at 8:46 am |
  63. Fedup

    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?

    August 7, 2009 at 8:46 am |
  64. Brian

    This is to: Bob August 7th, 2009 8:30 am ET, who wrote...
    "You don’t fix a problem by throwing trillions of dollars at it. You need to start at the roots, and work up, not at the top & work down."

    So tell me how trickle down economics worked out for everyone? Oh that's right, we ended up with "too big to fail" and multi-million dollar bonuses to crooks and thieves.

    August 7, 2009 at 8:44 am |
  65. John

    I love how people think that those opposed to health care 'reform' are against improving things or helping people. Don't be ridiculous. People want change and improvement but this reform bill is NOT it. Insurance premiums are so high already and keep going up BECAUSE of government control and regulations. Adding more, will not help the situation. More and more freedoms and choices will (are) be taken away. Less doctors will want to become doctors because of lower wages and then.... Ahh I'm sick of typing. If you don't know by now whats REALLY going on then you need to do your research. Its scary. Reform yes. THIS reform bill? NO!

    August 7, 2009 at 8:44 am |
  66. g. evans

    I think the Americans are dummies when it come to helping the poor. Its all about the rich keeping all they can. There are people who spend more on an outfit that they are only going going to wear one time, than lending a helping hand. I used to have insurance now I'm disable as millions of Americans, we paid into the system for years. I only want everyone to watch Michael Moore's "SICKO" So these nuts can see how stupid the really are.

    August 7, 2009 at 8:43 am |
  67. Henry

    And don't forget the fraud that Blue Cross commit many thousands of time each day against substance abuse & mental health agencies. BC/BS pays programs $28 per day for a service they should be paying $135 for 3 hours by denying they reimburse for the service...even though it is in their plan.

    Blue Cross also tells providers, and I quote: "just because it is a service we cover, doesn't mean we pay for it!"

    These are documented facts.

    August 7, 2009 at 8:41 am |
  68. Jac

    Out of the thousand pages of legislation, there isn't a single sentence that addresses the costs of fraud, nor the costs stemming from the ambulance chasing lawyers. It's going to do nothing but turn all our healthcare into something that resembles VA hospitals.

    I have no confidence in congress' ability to come up with a plan worth having. They don't want to live under the plan they're concocting so their trying to tell us it's a good thing is a joke.

    With their recent ad-hominem attacks on anyone who dares to say anything against the plan, it sealed the deal for me. I don't want the plan, I won't vote for anyone next cycle who supports it and no, I'm not carrying a nazi sigh, nor a radical, nor an extremest, nor was I paid to post this by some rich insurance company. I like, have an opinion. Evidently that's not allowed, unless it's the same opinion that Obama has. What a joke.

    August 7, 2009 at 8:41 am |
  69. doug

    No way these bozos can handle health care, they can't even keep their Ponzi scheme (social security) afloat much longer. And if they pass the Cap and Tax plan, what businesses will be left to pay for these big $ agendas? American companies can barely compete now with all the EPA programs they have to comply with cutting into productivity.
    And they say Bush made a mess? If B.O. gets his wish list our economy will be sucking as bad as the U.K.'s.

    August 7, 2009 at 8:40 am |
  70. Roland

    Just because the fraud that exists in the medicare system is there doesn't mean it isn't time to abandon the private delivery of health care. Fraud can be addressed, and as at least one poster observed, it is easier to address through a national data base. Also, don't think for a minute that the same kind of fraud that is stealing from medicare isn't rampant in private health care. If anything, it is also much more in the open, what with $10 charges for aspirin.

    As for the poster who asserts that the government has no incentive to root out fraud because it can just raise taxes, the lack of incentive among private insurers to not care about fraud is even greater and its even easier for them to just raise premiums. I have encountered a half a dozen situations where employers have documented workers compensation fraud (employees claiming lifting restrictions, or being unable to move in certain ways, and then being filmed working out at the gym or playing tackle football) and when the evidence is presented to the workers compensation carriers, they ignore it, finding it easier (for them) to just pass on the increases in premiums brought on by the claim fraud.

    The fact that fraud exists, or that it might not be adequately addressed at the present time, is a lame argument for not proceeding to fix a system that is broken and that will continue to cost more and more until we get to the point where very few have private health insurance and the rest of us get to be gouged by the supposed "customary and usual" ridiculous charges medical providers and hospitals charge those who are not part of a "discounted" in network group.

    Private health care has only itself to blame for the coming government take over of health care. It has failed so miserably and so often that it no longer provides a credible method for delivery of and access to health care.

    August 7, 2009 at 8:39 am |
  71. Carl

    Skyrocketing healthcare costs? What about skyrocketing, unsustainable cost of GOVERNMENT? At least when I pay my health care insurance premium, I get something in return. What do I get with increased cost of Government? More red tape, less service, longer wait times...oh, and by the way, better health care for illegal immigrants! NOTHING in the health care proposals put forth by the liberal democrats improves ANYTHING! All it will do is spread the pain of a corrupt and bankrupt medicaid/medicare system to all American taxpayers. It doesn't address fraud. It doesn't address malpractice. It doesn't address defensive medicine. It simply takes over yet another (huge) sector of the economy. President Obama gives great speeches about "nobody's talking about government-run health care". Yeah, nobody's talking about it because they want all the "sheeple" to just sit back and believe it won't happen until it's too late. Look at all of Obama's speeches BEFORE he was annointed president...where he tells audiences over and over that it will start with incremental government programs, but must eventually lead to total government control. This is all part of his and Congress' socialist agenda. Fight it with everything you have! Stand up to these morons and defend the republic! Otherwise it's only a matter of time before they change the stars in our flag to a hammer and sickle.

    August 7, 2009 at 8:37 am |
  72. Henry Okakpu

    Does GOP understand that in the end, the public will understand what the issues are? Do they realize that with the public finally understand the benefic of healthcare reform they will pay for missleading the public once again?

    August 7, 2009 at 8:36 am |
  73. MI1294

    Re: health care reform, little mention has been made re: the defensive medicine doctors are forced to practice in an attempt to avoid litigation in the event that they miss something. This drives up costs to a degree most of us cannot imagine.

    August 7, 2009 at 8:32 am |
  74. mike

    tim you're right its not JUST the doctors but some doctors are part of the problem too. Do you know that doctors that OWN ct scans perform 3x more ct scans than those that don't?

    doctors own surgery centers that take money from the system. there is so much profiteering from EVERYONE, insurers, doctors, hospitals, pharmecuticals etc.

    we need regulation of EVERYONE. If you regulated insurers for example that required a medical loss ratio of 80 or 85% you would have almost no profit from insurers and that argument would go away.

    oh and costs would still be going up.

    70% of amercican children are obese. that needs to be fixed. but why should it be if the government is going to come in and pay for everything??

    August 7, 2009 at 8:31 am |
  75. Bob

    You don't fix a problem by throwing trillions of dollars at it. You need to start at the roots, and work up, not at the top & work down.

    August 7, 2009 at 8:30 am |
  76. nyroze

    in response to some of the against reform emails, it seems to me that the reason people are against reform has nothing to do with the fact that overall health care is good but not great in this country. the republicans feel that reform needs to include further limitations on suing insurance companies or doctors, giving the consumers NO defense against a company that refuses to give people life saving treatment.

    there is no doubt that there is fraud, lawyers are greedy, doctors are not perfect and misdiagnose (there is a reason the second opinion mantra is used) and so on, but NO reform would perpetuate a system that refuses treatments for all kinds of reasons, leads to people going bankrupt, a system that is becoming so expensive that people search for less expensive coverage, which always means less care and less choice- meaning that you can only go to specific doctors and god forbid if there was no specialist such as the one you need. Children with developmental delays, learning disabilities, etc. who often need additional services do not get services, and in the mean time Health care companies are making record profits! (how bad can the fraud be if the companies are making such profits!)

    August 7, 2009 at 8:28 am |
  77. Keith Dobbins

    Of course the Republicans are the ones causing the turmoil at these town meetings. It's not whats good for the people - it's what's good for the party. And the sad thing is that both parties are capable of this.

    August 7, 2009 at 8:27 am |
  78. John

    It's not a debate if one side recites lies over and over. You cannot debate whether health care reform will kill the elderly in the same way you cannot debate wheter or not the Earth is flat. One side of this debate is simply lies that the extreme right propagate over and over. The president does not want a single payer option. Health care reform does not mean mandatory end of life counseling. You will not lose your insurance if you want to keep the plan you have. This reform debate should be about how to fix runaway health insurance costs that affect all Americans. Or the debate would be better served on focusing how many Americans lose their health insurance daily by becoming ill or losing their jobs. Hopefully there are enough democrats that will stand by the president and pass sensible health care reform. The president cannot do this by himself.

    August 7, 2009 at 8:27 am |
  79. bird

    And why would fraud go away of the Gov't ran health care? Look at defense contracts. Look at the Halliburton deals, Blackwater etc. The Gov't is big a bunch of crooks as you'll find anywhere.

    August 7, 2009 at 8:26 am |
  80. Conrad Shull

    Fraud oversight by the government has one drawback: bureaucrats who uncover it and prosecute it have their bonuses and positive performance reviews predicated on the number, not just quality, of invesitgations and prosecutions. Therefore, it is in the financial and career interest of investigators and prosecutors to go after not only real and obvious cheaters, but to go after, with equal force and tenaciousness, those doctors and hospitals who make minor, inadvertent mistakes, something very easy to do in the highly complex and convoluted world of healthcare and insurance rules and regulations.

    August 7, 2009 at 8:25 am |
  81. george

    Wake UP America. The people lobbying and disrupting town hall meetings are the ones who want to keep the fraud going. We need oversight. Quit selling out to the thieves.

    August 7, 2009 at 8:24 am |
  82. Steve

    Fraud does cost the tax payors money. I have a little different take on health care insurance fraud. I am a health care provider who provides services to BCBS policy holders. I have an insurance clerk I have to pay to review the payments made by BCBS. My contract states that they have to pay $11.80 for a particular service. Every few claims they just arbitrarily leave out a payment. They have it programed in there computers just to not pay the providers every once in a while. I have to hire some one to review the claims, that runs up the cost of health care also. How many poviders get cheated ? Typically we come up with several hundred dollors a week, of fraudulent payments. Who do I call about that. Do you think the states attorneys office will help me out. Not a chance.

    August 7, 2009 at 8:23 am |
  83. JF

    Good one, Larry! I'm sure the Gov will streamline things and remove all waste.

    August 7, 2009 at 8:22 am |
  84. Andra Kelly

    Any idiot can spend money, and that is what Obama is doing. It takes much stronger leadership to enact CHANGE in the way we spend, and take on real problems such as this. But Obama is doing nothing of the sort.
    Agree, there is lots of fraud. But the great health care plan does not address any of the important cost-saving issues: malpractice reform, defensive medicine, fraud, waste, and poor health habits. It wants electronic medical records, but there is no money to doctors to pay for it. It does little to change the complicated coding nightmare that encourages fraud. It creates arbitrary cuts, so that fraud and waste is necessary to keep doctor's businesses open. It creates in its own right "cadilac" insurance that invites fraud, rather than high – deductable plans that encourage patient participation and scrutiny over the health care the get. There is very little regulation over which codes get paid what and why; no reform of CMS (which sets rates to doctors and hospitals) and how private insurance follows CMS. There is little there to put responsibility on patients to stay healthy and live healthy. There is nothing to stop the end-of-life crazy spending by families, doctors, and hospitals, as if there is endless money for futile procedures and treatments.
    In the end, this proposal is just another socialist way of bringing everyone into the system, without fixing the system. And the system will bring us all down with its weight. And the system will be so burdensome and annoying that anyone with means will opt out of it - thus two tiered health care which we don't have now.
    Obama has good intentions, but there isn't enough political clout to make real changes except spend money. Anyone who spends money can do things, the real challenge is to change the way we spend money. And get people to do different things and go against trends, and strong lobbies. He has FAILED in that. Any idiot can spend money, that is easy. It takes much stonger leadership to change the way we spend the existing money.

    August 7, 2009 at 8:22 am |
  85. Tim

    Again, let's blame the doctors. How about we blame the people who at obese and smoke. The ones who's care cost a great deal and is TOTALLY preventable. Wake up. The vast majority of doctor make great sacrifices to do what they do and don't make 500K in 20 hours a week as some would assert. I work 70+ hours a week and get called a way from my family to care for yours. And I make a very reasonable 200K. Stop driving good people away from being your future doctor. Proscecute fraud. But don't pretend it is the root cause. Fix liability and you will remove the biggest cost – defensive medicine.

    August 7, 2009 at 8:20 am |
  86. mary

    Americans see this as another take over by this administration in an attempt to control our lives. And now we have had enough. Why is it that whenever a group questions, or disagrees with this Obama administration it is always portrayed as a group of right wing crazies?
    Maybe we are just concerned AMericanst

    August 7, 2009 at 8:20 am |
  87. Nona Hillard

    Republican’s will pay! This behavior is rude and Anti-American. Someone is going to get physically hurt! President Obama is trying so hard to help all American's. He is so humble, stating, “ It’s not about him”! Tragedy, the Republican Party cannot accept the fact that they lost! They have turned to ruthless vengeance, that brings out the worst evil in mankind. The vicious name-calling and mob tactics are barbaric. Respect for our fellow man must be our first objective, not mob rule! Secondly, my senators have abandoned our President in a time of crisis. Next election all those who do not have health care should go to the polls and let their elected official know how they feel, because party lines are deafening our elected officials. Of course the only way those people could vote is if they are Healthy enough to make it to the polls.

    August 7, 2009 at 8:20 am |
  88. ingrid, new york

    those people who are busy disrupting the town hall meetings, who are they? i think it would be fascinating to find out where they are getting their health care.... for example, many of them seem to be over 65 so we know they are actually on Medicare (guess who runs that?). those not on medicare- how many are govt. workers getting insurance essentially paid for by the govt. how many have a history of serious health problems so that they can actually see how their health care insurance works? and precisely what are they against? i would love to see the news "investigate" the above questions. chase the protesters after the protest and interview them, poll them, lets see who they really are.

    August 7, 2009 at 8:19 am |
  89. mike

    its a good thing private insurance investigates fraud like this. Medicare doesn't. that's 60 BILLION dollars that is wasted in the Medicare system. And we want to get MORE government control??

    August 7, 2009 at 8:19 am |
  90. Mariah

    The other reason health care reform will not be effective is because doctors do not listen or misdiagnose patients. When the doctor do not listen or misdiagnose, the cost to fix the ailment is astronomical!! I was told I had major depression for over 12 years and learned a year ago that it was not major depression but the real issue was that I had thyroid problems, my adrenal glands was not properly working...the cost for me out-of-pocket $450-$600 per month!!

    August 7, 2009 at 8:17 am |
  91. Mike

    They kind of health care reform that will reduce fraud and what Obama is talking about are two totally different things. If Obama would get off the public option and incorporate more tort reform into the package, I think you'd see a vast majority of Americans get behind it.

    August 7, 2009 at 8:16 am |
  92. FatSean

    Yet another argument for reform. I sat down and read through that bill, especially looking for all the 'bad' stuff that the anti-reformers claim is there. Most of their complaints are invalid, and the rest are almost insultingly obtuse interpretations of the text.

    *shrug* I've a high income and large net worth compared to most of the country. I don't need health care reform. Maybe I should just stop caring. Let the middle-aged screaming nutters who show up to disrupt town halls get what is coming to them.

    August 7, 2009 at 8:14 am |
  93. Scott

    What about patient fraud?

    I.E. malpractice suits brought forward by
    greedy lawyers and people out to get somethng for nothing?

    I guess the Obama administration doesn't want to mention that as a wasteful part of "healthcare reform" It might anger his consttuency,

    The people and attorneys that support him.

    August 7, 2009 at 8:14 am |
  94. Lora

    You are right Larry. Health care reform is needed to end the health care and insurance industries' monopolization. I just don't understand why the other wacky Americans just don't get it. I am for health care reform.

    August 7, 2009 at 8:09 am |
  95. RobK

    This is why government-run health care is bad. The government does not have much incentive to manage costs or fraud. They can just raise taxes. Even all-encompassing insurance is bad. The best solution is free-market competition, where consumers shop around for the best price. That eliminates most of the fraud. The only reason for insurance is catastrophic coverage.

    August 7, 2009 at 8:09 am |
  96. tcaudilllg

    This is a fool proxy. There's nothing to be done about the fraud save random investigations and follow up reports. Though explain to me how a non-licensed practicioner actually makes a claim?

    All it takes is a couple lines of code in the government's software to check if a doctor is deceased or not . If anything it's an argument FOR a national health system.

    August 7, 2009 at 8:09 am |
  97. Andrew

    The current "health insurance reform" proposal does not address problems of fraud. This is just another reason why the current bill needs to be trashed and a new one that addresses "health care reform" needs to be passed. Also, the current bill fails to address the problem of tort reform.

    If we don't address fraud & tort reform what is the point??

    August 7, 2009 at 8:07 am |
  98. Steve

    It amazes me how people can be against something that "helps"us.

    Don't you see what you are doing AMERICA!!! YOU ARE LOBBYIST FOR THE SAME COMPANIES (INSURANCE) WHO RAISED YOUR PREMIUMS LAST YEAR, WHO TOLD YOU THAT THEY WOULDN'T PROVIDE CARE FOR YOUR SICK KID, THAT YOUR CANCER TREATMENT WONT BE INSURED.

    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...So why not a public option. I hyper-extended my knee last month, went to the emergency room, they looked at my knee, gaVe me a prescription for a pain killer, put a brace on my knee; then sent me on my way. Weeks later I got a bill in the mail for $1500.00. I can't afford to pay that. If YOU DON'T want gov health care...DON'T SIGN UP FOR IT. And it amazes me because Medicare IS A GOV PROGRAM.. So I guess I'll be waiting, and my family will be waiting to see how this thing plays out. And I pray everyday that my little girl doesn't get sick.

    August 7, 2009 at 8:04 am |
  99. Noname

    If you want to FIX healthcare....start with SHOWING US you can fix what you already have including Medicare. Medicaid, the VA. and the Military.

    CMS LOSES $50 billion dollars a year due to improper payments including fraud and overcharges. FIX THAT. THEN we will talk.

    August 7, 2009 at 8:04 am |
  100. Larry

    This is why we need health care reform. Some estimates are that 1/3 of the total health care system is waste and fraud.

    August 7, 2009 at 7:48 am |
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