First of all, the crooks are getting enrolled somehow so it's at least in part an enrollment problem. If you could stop the enrollment, it's more direct and to the point of the massive fraud issue than addressing claims.
You're thinking like a bureaucrat.
Making the enrollment process "more difficult" does nothing toward solving the problem. If it did, the problem would already be solved as they have the most difficult enrollment process in the business today, by a mile.
You cannot stop the enrollment of people who will bilk the system when it is so easy to take so much money once it is done. It is worth the hassle when you can collect $10 Million over a period of months and go to Mexico and forget it.
If you want to prevent fraud, stop paying claims that aren't valid. The commercial insurers have stopped it. There is no reason competent operations at Medicare can't do the same. Commercial insurance requires NO enrollment but they're able to control fraud.
The problem is every bit as bad within state Medicaids -- our state currently has a 6 month enrollment backlog. But once you're enrolled, it is easy street.
Secondly, you don't know that she didn't discuss the claims end of the problem. We have just a few clips of her
This is true, however, I have seen no material change in the claims adjudication process in the last 20 years. The only changes are (a) they don't write checks anymore (using EFT instead, which, of course, doesn't require a physical address), and they provide remittance advices electronically only (which these criminals could care less about).
But 60 Mins could have discussed it and cut it out, but if so, they left the important part of the discussion on the floor. |
