SI
SI
discoversearch

We've detected that you're using an ad content blocking browser plug-in or feature. Ads provide a critical source of revenue to the continued operation of Silicon Investor.  We ask that you disable ad blocking while on Silicon Investor in the best interests of our community.  If you are not using an ad blocker but are still receiving this message, make sure your browser's tracking protection is set to the 'standard' level.
Politics : A US National Health Care System?
 Public ReplyPrvt ReplyMark as Last ReadFilePrevious 10Next 10PreviousNext  
To: Lane3 who wrote (10807)10/28/2009 9:56:15 AM
From: i-node2 Recommendations  Read Replies (2) of 42652
 
If Medicare had enough auditors and systems to stop the fraud, as private insurers do, overhead costs would go up.

The most telling part of the entire story is when they talked to the woman in charge at CMS, and her response was "We're trying to make the enrollment process more difficult" - or words to this effect.

I deal with Medicare enrollment daily, and it already an insane process requiring typically 100 pages of forms.

It is not an enrollment problem. They totally are barking up the wrong tree. It is a claims problem. And for the person in charge of digging out fraud not to know this is a fraud in itself.

70% of private insurers use software that evaluates the sensibility of claims, they have a process for questioning claims that JDLR, and that's what is needed at Medicare.

Medicare's claims processing is far simpler. A claim is paid or denied based on a the simplest of criteria (does this diagnosis go with the procedure, are we being billed for hysterectomies on males, this was an inpatient procedure, does the claim show the patient being hospitalized, etc.). There is no claim-to-claim comparison or in depth evaluation; only the most fundamental evaluation of claims occurs.
Report TOU ViolationShare This Post
 Public ReplyPrvt ReplyMark as Last ReadFilePrevious 10Next 10PreviousNext  

HomeMailHotSubjectMarksPeopleMarksKeepersSettings
Terms Of UseContact UsCopyright/IP PolicyPrivacy PolicyAbout UsFAQAdvertise on SI
© 2026 Knight Sac Media.  Data provided by Twelve Data, Alpha Vantage, and CityFALCON News