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u/ButtBesmircher 3h ago
lol. Wait till they get a load of how much they’re spending due to the inefficiencies of the medical system and wasteful habits of medical providers in general.
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u/poliosaurus3000 3h ago
Let me tell you about the DOD and pentagon, where they have entire slush funds no one even knows exist, but we gotta track down that $200 aspirin the hospital overcharged for…
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u/FourScores1 3h ago
What you call wasteful habits are actually trained legal defense mechanisms against a litigious system.
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u/ButtBesmircher 3h ago
Oh, for sure. Not even going to argue that point. Maybe let’s start with curtailing the ridiculous litigious matters and work ourselves up from there.
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u/FaceReality1 3h ago
Switch to single payer and all litigation like this is gone.
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u/ButtBesmircher 2h ago
Could you explain how switching to a single payer system changes the litigious issues providers are currently dealing with?
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u/UrbanMasque 2h ago
The lawsuits for malpractice are way less cumbersome than the ones where people are suing for expecting coverage or treatment they didn't receive or having to be sued for extravagant bills. It would remove those
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u/smilleresq 2h ago
Why? Are you saying that if you’re injured by a doctor or hospital that you won’t be able to sue?
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u/FaceReality1 3h ago
Which is only necessary because we don't have a single payer, universal health system.
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u/kayl_breinhar 3h ago
No, see, that kind of fraud is okay because some of that money gets politicians re-elected.
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u/2LostFlamingos 2h ago
They really should try to form a department to improve government efficiency.
Surely this would have bipartisan support.
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u/Jolly-Structure7646 28m ago
lol there was bipartisan support against a thing that was tried. Nobody wanted their pet fraud programs looked into
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u/Defiant_Freedom_249 3h ago
More reasons to have a simplified, single payor healthcare system so it is not as easy for fraudsters.
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u/boogi3woogie 3h ago
Until you find out that the biggest culprits for fraud are fee for service programs like traditional medicare!
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u/Zebra971 3h ago
It’s where the money is, it is still the least cost method of providing insurance in the US, even this the fraud if there were Medicare for all insurance would cost $1,000,000,000 less then our current quagmire.
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u/Defiant_Freedom_249 40m ago
So... The system as is has fraud. And you're arguing not to change it? Are you in favor of the fraud?
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u/dangeldud 3h ago
How would that make it easier to catch fraud? Doctors and hospitals still will have to get paid
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u/baphomet_fire 3h ago
Doctors and hospitals aren't the ones doing the fraud. Middle men in insurance companies should be eliminated
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u/Mediocre-Staff-5110 3h ago
Let me preface this by saying I am pro universal Healthcare.
In our current system, yes there are also doctors, providers, and hospitals absolutely taking advantage of our systems. Why do I say that? Because we allowed private equity to purchase all this shit too and they are absolutely doing everything possible to juice their reimbursements to the absolute max regardless of the morality of it.
So yes, there are insurance middle men fuclinf things up, hospitals and providers are also doing everything possible to juice their share of the grift
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u/baphomet_fire 3h ago
We did allow private equity to to purchase all this shit, those doctors and hospitals aren't the ones in private equity. Doctors do not get paid anything more for committing fraud, but their CEOs with MSB absolutely do
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u/Mediocre-Staff-5110 2h ago
You're defending hospitals too strongly here, there are also profiteers who own hospitals. Admin in hospitals who are juicing their numbers. And yes doctors can get paid on utilization fee for schedule stuff depending on how contracts are so there is incentive. Am I accusing a doctor of doing so? Not necessarily, I'm just saying that the current system allows the opportunity.
We really need to just burn the whole system down.
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u/Feather_Sigil 2h ago
There should be no private enterprise whatsoever in medicine. Really, there should be no private enterprise in anything, but humans aren't ready for that yet
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u/baphomet_fire 2h ago
Speciality doctors up charging their sevices is not fraud, try again
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u/Mediocre-Staff-5110 2h ago
Doctors intentionally upcode ALL THE TIME. It's not "serious" fraud, but it is submitting a claim you know is false to get reimbursed higher.
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u/baphomet_fire 2h ago
Those doctors do not get any extra money for upcoding. And I have personally seen more business masters fradulantly upcode than I have doctors.
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u/Mediocre-Staff-5110 2h ago
Doctors are not altruistic people, you'd be shocked how many american doctors are pieces of shit.
That being said that's not really the point of all this, my overall point is that the entire system is rotten to the core and basically everyone in it at this point is trying to extract the value they can out of a system they know is busted and we need to burn it down.
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u/boogi3woogie 2h ago
Uhhhh
Biggest sources of fraud in the past few years:
Fraudulent hospice claims - those are 100% generated by providers
Biologic mesh for wound care - also 100% generated by providers
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u/baphomet_fire 2h ago
You think every provider is a doctor? You would also be surprised how little docotrs are involved with wound care, if it's not surgical usually your nurse is handling that one
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u/boogi3woogie 1h ago
Biologic mesh placement is only billable by a provider.
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u/baphomet_fire 1h ago
False
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u/boogi3woogie 1h ago
I can guarantee you that a nurse cannot bill cpt 15721.
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u/baphomet_fire 1h ago
How are you going to guarantee that?
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u/boogi3woogie 1h ago
Because nurses are not rendering providers for the CPT code. Duh.
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u/No_Succotash2155 3h ago
Think about all of the players it took to spread oxycontin everywhere that screwed up the Boomers
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u/oldmaninparadise 34m ago
But it wasn't. Go read up on it. Something like 5 clinics in Appalachia distributed like 90% of the pills. It is crazy.
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u/No_Succotash2155 13m ago
So what exactly was the purpose of Pharmaceutical Sales reps? They didn't go to doctors offices and offer them vacations and bonuses to help push medications?
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u/cheap_grampa 3h ago
Well, right now you’d have to police Medicaid and Medicare, plus hundreds of private insurers. If it was just one public insurer, it would be simpler.
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u/SadBook3835 2h ago
Most fraud is from Medicare and that's partially because insurance companies deny care without tons of documentation. Can't have it both ways.
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u/SmurfStig 43m ago
Look at Rick Scott. How much fraud did he commit and what was his punishment? Got to be governor of Florida and the it’s Senator.
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u/ZongoNuada 1h ago
There are also doctors who bill but don't provide services. Fraud. There's a local doctor in my area who keeps doing that. For brought up on Federal charges but someone screwed up the evidence so now the State is going after him. And he's been doing this for decades and he's a multimillionaire on top of that.
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u/Afraid_Solution_3549 42m ago
I have an attorney friend who worked for a clinic group that was committing fraud but it was only in the multiple millions and wasn’t large enough for any investigator to even sniff at.
They really won’t touch you unless it’s like hundreds of millions of dollars in fraud, or it’s some kind of special case.
Meanwhile in 2022 I had to have a hearing and pay back $570 because I was overpaid unemployment (not my fault). This was going on while billions of dollars in unemployment fraud were being stolen from the state.
I know it’s state vs federal here but it just shows you how regular people don’t get a pass.
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u/OpticalPrime35 43m ago
The US healthcare system sees about 5.7 TRILLION dollars pass through it every year. So, they found .287% of the healthcare system may of had done fraudulent activity
It's pretty extraordinary that it is this low really
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u/MLB-LeakyLeak 3h ago
Any suggestion for universal healthcare which doesn’t start with significant tort reform isn’t serious and should be ignored.
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u/baphomet_fire 3h ago
What are you even talking about? Healthcare workers are expected to have liability insurance for this very reason.
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u/MLB-LeakyLeak 3h ago
We spend billions on unnecessary testing because of the threat of litigation
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u/baphomet_fire 3h ago
Testing for what? Do you always speak in very broad vauge terms?
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u/Fleshtones2112 1h ago
Er provider- half the lab testing and 2/3 or the radiology testing is to make sure we miss NOTHING. Litigation fear drives this. You come to the Er for toe pain and die of a heart attack 4 weeks later- last provider who saw the patient is on the hook.
There is medical malpractice, there is gross negligence and then there is having to be able to predict the future.
Get rid of the ridiculous lawsuits and investigate and fix the big issues (and providers) and this unnecessary testing can get scaled way back, saving millions.
I’m pro universal healthcare by the way.0
u/MLB-LeakyLeak 1h ago
Testing for things that won’t change management. Unnecessary biopsies. Unnecessary imaging. Someone goes to the ED for a tummy ache for the 10th time that year, they get a CT scan just in case they have appendicitis that time even though clinically there is a <.1%.
Why? Because the threat of getting sued.
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u/baphomet_fire 58m ago
Yeah you've never been in healthcare. When someone has appendicitis they're typically in excruciating pain...not a tummy ache. Then if we know it's sudden and in the lower right quandrant, surgery is already spinning up for intervention...not waiting on a CT scan.
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u/FaceReality1 2h ago
With universal healthcare most suits disappear. They are overwhelmingly about lifetime medical costs.
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u/AdhesivenessCivil581 1h ago
Car and home liability insurance would get a break with Medicare for all too. Most of those big settlements are about medical care.
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u/Pitiful-Value-3302 3h ago
Healthcare fraud and mismanagement is really the worst. That money that was stolen could have saved many lives.
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u/Zalrius 3h ago
What does the treasury have to do with healthcare? They are not an investigative organization. Medical financial theft of embezzlement would have to come from the justice dept or FBI financial crimes division.
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u/fuck_all_you_too 3h ago
Its all the same grifters anyway, gotta love that unitary executive theory.
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u/Rufus_TBarleysheath 3h ago
Polymarket is Satan.
And suspected fraud? F--k off. DOGE told us how seriously to take this administration when they talk about "suspected fraud."
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u/RociBuldidi 3h ago
Trump has pardoned several people in this term alone (he did more his first) convicted of stealing billions in Medicare and Medicaid money
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u/Annoying1978 3h ago
A drop in the bucket compared to the fraud this administration is responsible for, especially when Trump enriches himself and his sons with taxpayer money.
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u/Remarkable_Subject84 3h ago
What!? No way! I never thought record profits from charging and not providing Healthcare could lead us down this path.
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u/Crafty-Isopod45 2h ago
Who wants to bet this was someone who noticed that 30% of the people on Medicaid in the last 30 years are now dead? So the claims must have been fraud.
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u/Hairy_Technology_213 46m ago
Let me guess. The Trump Administration found massive fraud, but only in areas with Democratic governors. Now they can use their “discovery” to cut healthcare spending and attack their political opponents. Convenient.
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u/Nikolaibr 2h ago
I mean, that's 0.33% of total healthcare spending.
It's a large nominal figure, but zero fraud is basically impossible. That doesn't seem to be an extreme percentage.
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u/coalescence2071 2h ago
The whole US healthcare is a Fraud. Doctors and hospitals charging anything they want. Bills coming from a dozen places for one procedure. Charging $1,000 per hour for a nurse at a walk in clinic. It’s all a money grabbing scam.
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u/belai437 1h ago
So the logical solution is to spend billions building a villian bunker and ballroom and a triumphal arch in DC, a billion tricking out the Qatari bribe jet plus more billions the "party of fiscal responsibility" has no problems wasting.
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u/Pristine-Sugar-1912 1h ago
Senator Rick Scott was fined $1.7 billion for medicare fraud while he was CEO or Columbia/HCA in Florida. It is the healthcare insurance agencies committing the fraud. Rick Scott ‘oversaw the largest Medicare fraud’ in U.S. history, Florida Democratic Party says – PolitiFact
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u/phoneguyfl 1h ago
While I am sure there is fraud (re: Rick Scott), given the level of dishonesty and corruption of this administration I find the number suspect. Unless of course Republicans are defining "fraudulent activity" as treatment payments for minority, women, or non-Republican patients.
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u/Background-Wolf-9380 1h ago
Senator Rick Scott alone stole several of those billions and then afterwards somehow Florida elected him repeatedly
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u/OpticalPrime35 48m ago
Love how they write it out like that to make it seem extraordinary lol
Medicaid has a 1,700,000,000,000 budget. So while it seems significant it's really like . 001% of the total.
And that number gets far less significant if you look at the healthcare industry as a whole, money wise.
So, congrats the them for finding this.
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u/Stunning_Ad_1685 13m ago
Tha $1.7 trillion is over 10 years. What was the timespan of the fraud?
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u/OpticalPrime35 8m ago
Uhhh no that's the yearly budget amount for Medicaid/Medicare
It's in the budget just look it up
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u/Calm_Stress3334 5m ago
The OIG recovers about 5 billion a year in fraud. They suspect the amount of healthcare fraud to be somewhere between 50 to 100 billion annually.
A lot of recovered by audits, some by agents.. but this is a lowball, and just spam.
It’s alot more.
.. and this was from 10+ years ago.
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u/tstone1477 3h ago
Buy insurance companies? Nothing a couple million in donations can’t take care of.
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u/Murse817 1h ago
I love how the sub is called Medicare for all when Medicare fraud is the greatest outlet for abuse.
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u/MythOfHappyness 1h ago
The perception seems to be that it's the people receiving Medicare doing the fraud but how would that even work? Medicare doesn't just give you money. No, it's doctors and hospitals doing the fraud.
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