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Medicare loses 60 BILLION DOLLARS a year in FRAUD.....That over 10% of their entire total costs to FRAUD alone.

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Medicare loses 60 BILLION DOLLARS a year in FRAUD.....That over 10% of their entire total costs to FRAUD alone.

 

SHOCKING!!!

But not surprising.

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9 minutes ago, DeepBreath said:

Look up how much private insurance loses in fraud every year. 

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2 minutes ago, dontlooknow said:

The fact is medicare loses less in fraud than private insurance. 

False.

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In 2011, at least $82 billion and as much as $272 billion was wasted on fraud and abuse in the health care system. That’s 3-10% of all health care spending in the U.S.

Health care fraud can be anything from upcoding (recording patients’ conditions as sicker than they really are to reap a higher reimbursement) to charging for services never delivered, to identity theft and more. Some scammers, like personal trainer David Williams, even pretended to be doctors so they could receive lucrative reimbursements from insurance companies.

What are health insurers doing about the real threat of fraud and abuse? Unlike Medicare and Medicaid, which file thousands of lawsuits against scammers, private health insurers are doing much less to prosecute individuals for fraud, journalist Marshall Allen found in an investigation for ProPublica.

Why aren’t health insurers suing and prosecuting people for fraud, when they are getting ripped off to the tune of millions of dollars each year? According to Allen’s interviews with numerous former fraud investigators, insurers don’t prioritize policing fraud because doing so would hurt their profits.

Many of the people committing insurance fraud are providers themselves, who game the system to bill insurance companies for as much as possible. But if private insurers prosecuted every provider who committed fraud, they could lose some providers from their network. And maintaining a large network is key for insurance companies to attract new employers.

More importantly, insurance companies may feel the initial financial loss from fraud, but they can always make up those losses by increasing their premiums, reducing benefits, or increasing co-pays. Its the same twisted logic behind why some private insurers accept ridiculously high hospital prices.

“The bottom line is significant: If a con artist, or a corrupt medical professional, makes off with health care dollars, those losses are not necessarily the insurers’,” Allen writes.

So how can we reduce fraud when insurance companies wont undertake the effort on their own? In an accompanying piece, Allen suggests a few policy changes to reduce fraud:

  • States should require insurers to report suspected cases of fraud to regulators, so states can track levels of fraud and hold insurers accountable for prosecuting scammers. Currently most states already do this, but at least ten do not.
  • Insurance companies should be fined for not reporting fraud cases to state regulators, if they are in a state in which reporting is required.
  • Medicare and private insurance companies should verify that all people requesting a billing number are licensed health care professionals.

Allen’s investigation demonstrates how health care institutions often act to maximize profits, even if it harms patients and goes against their stated mission. When it comes to fraud investigation, insurers are not acting on behalf of patients, and will not do so until they are held accountable.

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Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.

Health insurers are regarded as fierce defenders of health care dollars. But the case of David Williams shows one reason America’s health care costs continue to rise. The personal trainer spent years posing as a doctor and billing the nation’s top insurers, making off with millions.

by Marshall Allen

 July 19, 2019, 7 a.m. EDT
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ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for ProPublica’s Big Story newsletter to receive stories like this one in your inbox as soon as they are published.

This story was co-published with Vox.

Ever since her 14-year marriage imploded in financial chaos and a protective order, Amy Lankford had kept a wary eye on her ex, David Williams.

Williams, then 51, with the beefy body of a former wrestler gone slightly to seed, was always working the angles, looking for shortcuts to success and mostly stumbling. During their marriage, Lankford had been forced to work overtime as a physical therapist when his personal training business couldn’t pay his share of the bills.

So, when Williams gave their three kids iPad Minis for Christmas in 2013, she was immediately suspicious. Where did he get that kind of money? Then one day on her son’s iPad, she noticed numbers next to the green iMessage icon indicating that new text messages were waiting. She clicked.

What she saw next made her heart pound. Somehow the iPad had become linked to her ex-husband’s personal Apple device and the messages were for him.

Most of the texts were from people setting up workouts through his personal training business, Get Fit With Dave, which he ran out of his home in Mansfield, Texas, a suburb of Fort Worth. But, oddly, they were also providing their birthdates and the group number of their health insurance plans. The people had health benefits administered by industry giants, including Aetna, Cigna and UnitedHealthcare. They were pleased to hear their health plans would now pay for their fitness workouts.

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The accusations are Medicare fraud, conflict of interest and insider trading. Bill Frist’s connection to his family’s Hospital Corporation of America (HCA) has landed him in hot water and earned him a subpoena from the U.S. attorney for the Southern District of New York and an investigation by the Securities and Exchange Commission.

HCA Inc., an international chain of hospitals founded in 1968 by Frist’s father, Thomas Frist Sr., and brother, Thomas Frist Jr., is one of the top-10 health care services companies, ranked by sales, according to Yahoo Finance. If you spot something you think we should add, let us know at uncovered@truthdig.com.

BACKGROUND

MEDICARE FRAUD

| As reported by Doug Ireland of LA Weekly, Hospital Corporation of America was the subject of a decade-long federal investigation into suspected criminal fraud involving double bookkeeping and the overbilling of Medicare, Medicaid and Tricare. In 1997, at the pinnacle of a government crackdown on the healthcare industry’s defrauding of Medicare, HCA, then Columbia/HCA, was charged with conspiring to overbill Medicare and Medicaid, the federal healthcare programs for the elderly and the poor, by more than $1.7 million. HCA has since paid a total of $1.7 billion in fines, the largest fraud settlement in U.S. history. Following the settlement, HCA was allowed to continue its Medicare contracts.

 

 

CONFLICT OF INTEREST | Frist’s financial disclosure statement this year placed the value of his blind trusts at between $7 million and $25 million, according to The Washington Post. Frist placed his investments in a blind trust when he joined the Senate to avoid the appearance of conflict of interest. However, contrary to Frist’s initial statements, the blind trust provided him with regular updates on the status of his assets, according to the Associated Press. 

INSIDER TRADING INVESTIGATIONS | On Sept. 21, 2005, Jonathan Katz of the Associated Press reported that Frist had instructed a trustee managing his assets to sell all of his HCA stock as well as that of his wife and children. All of their shares of HCA stock were sold by July 8, two weeks before HCA issued a disappointing earnings report leading to a 15 % drop in share price. Katz also reported that Frist claimed that the order was given to avoid the appearance of conflict of interest over his participation in healthcare legislation, and that he possessed no nonpublic information when the stock was sold (contrary to correspondence between the trustee and Frist family now on file with the Senate). The U.S. attorney for the Southern District of New York has issued subpoenas to investigate the sale, and the U.S. Securities and Exchange Commission has also issued a subpoena. 

 

 

FRIST’S FOCUS ON HEALTHCARE | Before Frist was a household name, and before the HCA Medicare fraud scandal broke, he was active for the Bush-Quayle administration and in Tennessee politics. Frist chaired the Tennessee Medicaid Task Force from 1992-1993, the Republican National Committee’s Health Care Coalition’s National Steering Committee and George H.W. Bush-Dan Quayle ’92, and was deputy director of the Tennessee Bush-Quayle ’92 campaign.

Frist has held the following special assignments according to his “Spotlight on Healthcare” page:

  • Vice Chairman, Alliance for Health Reform (1997-present)
  • Co-Chairman, CSIS Task Force on Strengthening US Leadership on HIV/AIDS (2001-present)
  • Member, The Congressional Heart and Stroke Coalition
  • Member, National Bipartisan Committee on the Future of Medicare (1998-1999)
  • Chairman, Senate Republican Medicare Working Group (August 1995-October 1996)
  • Chairman, Senate Subcommittee on Disability Policy (1996)
BIOGRAPHICAL INFO

BiographyCurriculum Vitae of the Honorable William H. Frist

 

 

FILES

Frist’s Votes Found to Favor HCA InterestsDec. 4, 2005

| The Associated Press reported: “An analysis of Senate Majority Leader Bill Frist’s voting record shows a pattern of supporting bills that benefit HCA Inc., the Nashville-based hospital company that’s been the foundation of the Frist family’s wealth.” more

Investigations Involving Congress Members
Nov. 28, 2005 | The Associated Press reports: “Senate Majority Leader Bill Frist, R-Tenn.: The Securities and Exchange Commission and the Justice Department are investigating Frist’s sale of millions of dollars worth of stock in HCA, the Nashville-based hospital chain founded by his father and brother.” more

Documents Contradict Comments on Holdings
Oct. 24, 2005 | Jeffrey H. Birnbaum of the Washington Post reports: “Senate Majority Leader Bill Frist (R-Tenn.) was given considerable information about his stake in his family’s hospital company, according to records that are at odds with his past statements that he did not know what was in his stock holdings.” more

Frist Sold Stock Before Price Dropped
Sept. 21, 2005 | Jonathan M. Katz reported for the Associated Press: “Senate Majority Leader Bill Frist, a potential presidential candidate in 2008, sold all his stock in his family’s hospital corporation about two weeks before it issued a disappointing earnings report and the price fell nearly 15 percent.” more

Upon Frist’s Senate majority leader nomination:
Bad Doctor
Jan. 10, 2003 | Doug Ireland of the LA Weekly reported: “While TV gushed last week over the Republicans new Senate majority leader, Bill Frist, intervening in a traffic accident, portraying the former heart surgeon as a ‘Good Samaritan,’ in truth the GOP has simply replaced a racist with a corporate crook.” more

Regarding HCA and Medicare fraud:
NewsHour with Jim Lehrer “Doctoring the Books”
July 31, 1997 | “Three Columbia/HCA executives were charged with defrauding Medicare programs for more than a decade, underscoring the government’s growing investigation into healthcare fraud. After a backgrounder, Margaret Warner will lead a discussion on Columbia/HCA’s defrauding of medicare.” 

RELATED SITES

Frist’s Senate PageCitizens for Responsibility and Ethics in WashingtonOct. 25, 2005

| Citizens for Responsibility and Ethics in Washington (CREW) has filed the second of two complaints with the Senate Select Committee on Ethics against Sen. William Frist (R-Tenn.). The second complaint alleges that Sen. Frist was well aware that he held HCA stock at a time when he denied any knowledge of such holdings. The complaint points to recent press reports and letters from trustees to Frist as evidence that the senator was aware of his holdings. 

Press Release
1st Complaint
2nd Complaint

 

 

MULTIMEDIA

Listen:
SEC Inquiry into Frist Stock Sale Deepens
Oct. 13, 2005 | David Welna for NPR’s “All Things Considered”

Watch:
NewsHour with Jim Lehrer “Doctoring the Books”
July 31, 1997 | “Three Columbia/HCA executives were charged with defrauding medicare programs for more than a decade, underscoring the government’s growing investigation into healthcare fraud. After a backgrounder, Margaret Warner will lead a discussion on Columbia/HCA’s defrauding of Medicare.”

 

 

 
 

 

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Just now, dontlooknow said:

You want to see more deep throat?

You lied or you're just plain stupid. I don't need to see more to prove that. 

 

2. Medicare is using private insurance more and more to REDUCE COSTS, dummy. 

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Just now, DeepBreath said:

You lied or you're just plain stupid. I don't need to see more to prove that. 

 

2. Medicare is using private insurance more and more to REDUCE COSTS, dummy. 

Hey dummy the private insurance company's don't care about fraud and loses 10% so you have to pay higher premiums. 

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Just now, dontlooknow said:

Hey dummy the private insurance company's don't care about fraud and loses 10% so you have to pay higher premiums. 

They don't care cause you will just have to pay higher premiums. 

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Just now, dontlooknow said:

They don't care cause you will just have to pay higher premiums. 

It doesn't come out of their pocket. 

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And private healthcare insurance rates went up 3% last year. Lower under Obamacare than the 10% a year under bush. 

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3 minutes ago, merrill said:
 

The accusations are Medicare fraud, conflict of interest and insider trading. Bill Frist’s connection to his family’s Hospital Corporation of America (HCA) has landed him in hot water and earned him a subpoena from the U.S. attorney for the Southern District of New York and an investigation by the Securities and Exchange Commission.

HCA Inc., an international chain of hospitals founded in 1968 by Frist’s father, Thomas Frist Sr., and brother, Thomas Frist Jr., is one of the top-10 health care services companies, ranked by sales, according to Yahoo Finance. If you spot something you think we should add, let us know at uncovered@truthdig.com.

BACKGROUND

MEDICARE FRAUD

| As reported by Doug Ireland of LA Weekly, Hospital Corporation of America was the subject of a decade-long federal investigation into suspected criminal fraud involving double bookkeeping and the overbilling of Medicare, Medicaid and Tricare. In 1997, at the pinnacle of a government crackdown on the healthcare industry’s defrauding of Medicare, HCA, then Columbia/HCA, was charged with conspiring to overbill Medicare and Medicaid, the federal healthcare programs for the elderly and the poor, by more than $1.7 million. HCA has since paid a total of $1.7 billion in fines, the largest fraud settlement in U.S. history. Following the settlement, HCA was allowed to continue its Medicare contracts.

 

 

CONFLICT OF INTEREST | Frist’s financial disclosure statement this year placed the value of his blind trusts at between $7 million and $25 million, according to The Washington Post. Frist placed his investments in a blind trust when he joined the Senate to avoid the appearance of conflict of interest. However, contrary to Frist’s initial statements, the blind trust provided him with regular updates on the status of his assets, according to the Associated Press. 

INSIDER TRADING INVESTIGATIONS | On Sept. 21, 2005, Jonathan Katz of the Associated Press reported that Frist had instructed a trustee managing his assets to sell all of his HCA stock as well as that of his wife and children. All of their shares of HCA stock were sold by July 8, two weeks before HCA issued a disappointing earnings report leading to a 15 % drop in share price. Katz also reported that Frist claimed that the order was given to avoid the appearance of conflict of interest over his participation in healthcare legislation, and that he possessed no nonpublic information when the stock was sold (contrary to correspondence between the trustee and Frist family now on file with the Senate). The U.S. attorney for the Southern District of New York has issued subpoenas to investigate the sale, and the U.S. Securities and Exchange Commission has also issued a subpoena. 

 

 

FRIST’S FOCUS ON HEALTHCARE | Before Frist was a household name, and before the HCA Medicare fraud scandal broke, he was active for the Bush-Quayle administration and in Tennessee politics. Frist chaired the Tennessee Medicaid Task Force from 1992-1993, the Republican National Committee’s Health Care Coalition’s National Steering Committee and George H.W. Bush-Dan Quayle ’92, and was deputy director of the Tennessee Bush-Quayle ’92 campaign.

Frist has held the following special assignments according to his “Spotlight on Healthcare” page:

  • Vice Chairman, Alliance for Health Reform (1997-present)
  • Co-Chairman, CSIS Task Force on Strengthening US Leadership on HIV/AIDS (2001-present)
  • Member, The Congressional Heart and Stroke Coalition
  • Member, National Bipartisan Committee on the Future of Medicare (1998-1999)
  • Chairman, Senate Republican Medicare Working Group (August 1995-October 1996)
  • Chairman, Senate Subcommittee on Disability Policy (1996)
BIOGRAPHICAL INFO

BiographyCurriculum Vitae of the Honorable William H. Frist

 

 

FILES

Frist’s Votes Found to Favor HCA InterestsDec. 4, 2005

| The Associated Press reported: “An analysis of Senate Majority Leader Bill Frist’s voting record shows a pattern of supporting bills that benefit HCA Inc., the Nashville-based hospital company that’s been the foundation of the Frist family’s wealth.” more

Investigations Involving Congress Members
Nov. 28, 2005 | The Associated Press reports: “Senate Majority Leader Bill Frist, R-Tenn.: The Securities and Exchange Commission and the Justice Department are investigating Frist’s sale of millions of dollars worth of stock in HCA, the Nashville-based hospital chain founded by his father and brother.” more

Documents Contradict Comments on Holdings
Oct. 24, 2005 | Jeffrey H. Birnbaum of the Washington Post reports: “Senate Majority Leader Bill Frist (R-Tenn.) was given considerable information about his stake in his family’s hospital company, according to records that are at odds with his past statements that he did not know what was in his stock holdings.” more

Frist Sold Stock Before Price Dropped
Sept. 21, 2005 | Jonathan M. Katz reported for the Associated Press: “Senate Majority Leader Bill Frist, a potential presidential candidate in 2008, sold all his stock in his family’s hospital corporation about two weeks before it issued a disappointing earnings report and the price fell nearly 15 percent.” more

Upon Frist’s Senate majority leader nomination:
Bad Doctor
Jan. 10, 2003 | Doug Ireland of the LA Weekly reported: “While TV gushed last week over the Republicans new Senate majority leader, Bill Frist, intervening in a traffic accident, portraying the former heart surgeon as a ‘Good Samaritan,’ in truth the GOP has simply replaced a racist with a corporate crook.” more

Regarding HCA and Medicare fraud:
NewsHour with Jim Lehrer “Doctoring the Books”
July 31, 1997 | “Three Columbia/HCA executives were charged with defrauding Medicare programs for more than a decade, underscoring the government’s growing investigation into healthcare fraud. After a backgrounder, Margaret Warner will lead a discussion on Columbia/HCA’s defrauding of medicare.” 

RELATED SITES

Frist’s Senate PageCitizens for Responsibility and Ethics in WashingtonOct. 25, 2005

| Citizens for Responsibility and Ethics in Washington (CREW) has filed the second of two complaints with the Senate Select Committee on Ethics against Sen. William Frist (R-Tenn.). The second complaint alleges that Sen. Frist was well aware that he held HCA stock at a time when he denied any knowledge of such holdings. The complaint points to recent press reports and letters from trustees to Frist as evidence that the senator was aware of his holdings. 

Press Release
1st Complaint
2nd Complaint

 

 

MULTIMEDIA

Listen:
SEC Inquiry into Frist Stock Sale Deepens
Oct. 13, 2005 | David Welna for NPR’s “All Things Considered”

Watch:
NewsHour with Jim Lehrer “Doctoring the Books”
July 31, 1997 | “Three Columbia/HCA executives were charged with defrauding medicare programs for more than a decade, underscoring the government’s growing investigation into healthcare fraud. After a backgrounder, Margaret Warner will lead a discussion on Columbia/HCA’s defrauding of Medicare.”

 

 

 
 

 

 

Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.

 

Insurers make paperwork confusing because “they realize that people will just simply give up and not pursue it” if they think they have been shortchanged, Potter said.

 

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/24/AR2009062401636.html

 

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1 minute ago, merrill said:

 

Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released yesterday by the staff of the Senate Commerce Committee.

 

Insurers make paperwork confusing because “they realize that people will just simply give up and not pursue it” if they think they have been shortchanged, Potter said.

 

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/24/AR2009062401636.html

 

Talk about getting ripped off. 

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Moreover, tax dollars also pay for critical elements of the health care system apart from direct care—Medicare funds much of the expensive equipment hospitals use, for instance, along with all medical residencies.

 

Recognizing these hidden costs that U.S. households pay for health care today makes it far easier to see how a universal single-payer system—with all of its obvious advantages—can cost most Americans less than the one we have today.

 

Medicare must exist in the fragmented world that is American health care—but no matter how creative the opponents of single-payer get, there is no way they can show convincingly how the administrative costs of a single-payer system could come close to the current level.

 

More on this matter:

http://www.dollarsandsense.org/archives/2008/0508harrison.html

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5 minutes ago, dontlooknow said:

Hey dummy the private insurance company's don't care about fraud and loses 10% so you have to pay higher premiums. 

FALSE. 

 

You presented something from 2011 who's claims it's from 3-10% 

 

I presented something from 2015 that Medicare fraud is OVER 10%

 

Medicare NOW uses private HMO's to try and control costs and fraud. 

 

Try and be not so stupid. 

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Just now, DeepBreath said:

FALSE. 

 

You presented something from 2011 who's claims it's from 3-10% 

 

I presented something from 2015 that Medicare fraud is OVER 10%

 

Medicare NOW uses private HMO's to try and control costs and fraud. 

 

Try and be not so stupid. 

So private insurance has fraud at the same rate. 

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4 minutes ago, merrill said:

Moreover, tax dollars also pay for critical elements of the health care system apart from direct care—Medicare funds much of the expensive equipment hospitals use, for instance, along with all medical residencies.

 

Recognizing these hidden costs that U.S. households pay for health care today makes it far easier to see how a universal single-payer system—with all of its obvious advantages—can cost most Americans less than the one we have today.

 

Medicare must exist in the fragmented world that is American health care—but no matter how creative the opponents of single-payer get, there is no way they can show convincingly how the administrative costs of a single-payer system could come close to the current level.

 

More on this matter:

http://www.dollarsandsense.org/archives/2008/0508harrison.html

This is an absolute lie that's been debunked over and over and over. 

 

The fact Medicare has been using HMO's to cut costs dispels your talking point, IDIOT. 

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Just now, dontlooknow said:

So private insurance has fraud at the same rate. 

No. They don't have fraud at the same rate, DUMBASS. 😂

 

You're mathematically challenged.  

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1 minute ago, DeepBreath said:

No. They don't have fraud at the same rate, DUMBASS. 😂

 

You're mathematically challenged.  

Hey idiot frauds are going to defraud any system. Hello mcfly. 

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Just now, dontlooknow said:

Hey idiot frauds are going to defraud any system. Hello mcfly. 

Except private insurers have done much more to combat fraud which is why Medicare is turning MORE and MORE of their administration over to the private sector, IDIOT. 

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