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Re: No LBC---Mass. (mass) Health Insurance

To: "Robert E. Shlafer" <pilotrob@webtv.net>, Spridgets
Subject: Re: No LBC---Mass. (mass) Health Insurance
From: b-evans@earthlink.net
Date: Sun, 07 Jan 2007 23:27:33 -0800
Robert E. Shlafer wrote:  "One thing for sure, it (the Massachusetts 
plan) will require good financial oversight/monitoring if Medicare is 
any example."

Unfortunately, the very size of the Medicare program makes it open 
season for outright fraud as swell as rampant abuse (such as ordering 
unnecessary tests, equipment, or therapy).   In a 2005 report, the 
General Accounting Office reported that an estimate 10 percent of 
provider claims were fraudulent.  At the same time, the retired chief 
investigator of Medicare fraud in New York claimed that in 2004, $18 
BILLION or *40 percent* of provider claims were either fraudulent or 
abuse.  If the same were true nationally, that would mean that $136 
BILLION went for fraud or abuse.

I became interested in Medicare fraud last year when I discovered that 
the "diabetic shoes" that I was provided with under Medicare were part 
of a fraudulent nationwide scheme involving the manufacturer and 
podiatrists.  After I received them, I learned that the podiatrist 
charged Medicare $340 for the shoes and supposedly "special" inserts.  
In my own investigation, I learned that earlier in the year, the shoe 
company had been raided by the FBI seeking evidence that it had been 
selling shoes and inserts that it knew did not meet Medicare 
requirements.  No charges had yet been filed at that time, but my shoes 
and inserts were clearly not to requirements.  Before turning my 
evidence over to the FBI, I questioned the doctor who was highly irate 
that a simpleton patient should question him.  Ironically, he blatantly 
gave me paperwork from the company that buried them even deeper.

Unfortunately, everyone from investigators and prosecutors to the GAO 
agree that the problem is that Medicare to far too massive and complex, 
while at the same time "lightly policed".  Oh, yes, any my shoes did not 
fit!

Buster




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