Silicon Investor (SI) -- The First Internet Community

STOCKTALK

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 : Formerly About Advanced Micro Devices -- Ignore unavailable to you. Want to Upgrade?

To: Broken_Clock who wrote (779198)	4/9/2014 1:13:47 PM
From: i-node	1 Recommendation Recommended By TideGlider Read Replies (1) \| Respond to of 1575354

>> No link? just fact? koan lives! IF you want to research it and become educated on the subject here is a good starting point: hks.harvard.edu "The units of measure for losses due to health care fraud and abuse in this country are hundreds of billions of dollars per year. We just don't know the first digit. It might be as low as one hundred billion. More likely two or three. Possibly four or five. But whatever that first digit is, it has eleven zeroes after it. These are staggering sums of money to waste, and the task of controlling and reducing these losses warrants a great deal of serious attention. One of my deep regrets is to discover that academia has paid almost no serious attention to this critical problem. I suspect this neglect is because the art of health care fraud control falls awkwardly between the traditional disciplines of health economics, health policy, crime control policy, anomaly detection and pattern recognition." This is at odds with the government assessment of 60B/y. This is correct. I could EASILY defraud Medicare out of 100s of millions of dollars in the coming 18 months and get away with it. Only because I'm not a criminal would I not do it. It is that damned easy, all electronically, nice and neat. And the knowledge required is not that special; I've worked with medical claims systems for 20 years, and I can tell you the internal controls on government programs, particularly Medicare, are nonexistent. I could not do the same with commercial insurance, BTW, because they safeguard their assets. I could bilk Medicaid out of significant money but it would be harder since most states have gotten wise to the transportation schemes. Medicare and Medicaid both use as fraud prevention a totally stupid technique: Trying to catch fraud when the criminal biller enrolls instead of when they file claims. Commercial insurance companies stop fraud on the claim level. What this means is that once you're enrolled in Medicare, as long as you coding claims correctly, the money keeps rolling. And in fact, once you are rolling, the only way you're going to get caught is to stop doing it (which causes your account to go dormant).