On Mar. 23rd, mcbr0094 from the University of Minnesota wrote a great piece on their blog, entitled:

Winning the Lottery an Every Day Occurrence: Medicare Fraud

I would like to share a personal anecdote that I witnessed first hand that shows how Medicare fraud affects not only our pocket books, but more importantly, elderly citizens (and particularly those who are poor.

When I first began working in the area of Medicare related insurance, I was helping folks in the Dallas area with Medicare Advantage plans that were specifically designed for folks who were designated as “dual eligible” (they had both Medicare and Medicaid).

The benefits that were offered by this Advantage plan far exceeded the benefits beneficiaries received from Medicare and Medicaid. Beneficiaries could receive services, such as no cost health club membership, no cost eye ware, no cost hearing aids, rides to the their doctor, and so on.

It baffled me then, when I began to run into folks who were not even interested in this plan (or similar plans). What I began to discover was that some of the “Home Health Care” agencies that were taking care of these folks were committing all kinds of billing fraud. In some cases, they might be double billing Medicare and Medicaid for the same services, or simply lying about the amount of hours they were providing care.

None of these “under the radar” services were approved vendors by any of the big plans and as I began to discover, they ONLY served clients who were dual eligible.

These fraudulent practices were so profitable that they would actually pay the client an incentive (usually about $100 per month) to keep their services (and not switch to a plan that wouldn’t pay them).

For many of these clients, $100 a month was like hitting it big! Many of these folks were very poor and enjoyed no discretionary income whatsoever.

It was a very sad scene indeed. People were actually turning away far superior health benefits that could help them remain healthy. The value of these benefits far exceeded $100 per month. Nevertheless, I understand why they kept the cash. For many of them in abject poverty, it was like a drug. Those who committed the fraud, like drug pushers.

Those who perpetrated this crime may have “won the lottery,” but in the end, everyone else pays the price. The “least of these,” our aged and poor are those who suffer the most.

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In an amazing story by Bloomberg and David Olmos posted yesterday, Dec. 31 (Bloomberg) — The Mayo Clinic, praised by President Barack Obama as a national model for efficient health care, will stop accepting Medicare patients as of tomorrow at one of its primary-care clinics in Arizona, saying the U.S.

http://www.bloomberg.com/apps/news?pid=20601087&sid=aHoYSI84VdL0

This story is really big news for Medicare. It is my opinion that Mayo has fired a shot across the bow. Many in government have stated the desire to cut Medicare and now, health care providers are fighting back.

Medicare and Medicare reform are going to be a huge topic of discussion as more and more seniors are marginalized and left without adequate coverage.

The Denver Post published a piece this weekend entitled: Many Colo. seniors fret on health reform.

Is anyone surprised by this? While many seniors would love to see everyone have the same opportunity for healthcare as those who get Medicare, most realize the impracticability and impossibility of such a notion. It is a little like saying that everyone who “shows up” for the game should get a winning trophy!

To compare Medicare with something like a “public health care plan,” is downright silly. If you are eligible for Medicare, or soon will be, then you know that getting access to a great health care system is something you have earned. You have worked hard, supported our country, and participated in our great democracy. Nobody gave you anything. You worked for it and waited for it and now you will receive your reward.

Politicians pitching for “government controlled” health care reform believe that everyone has a “right” to Medicare-like access. Most seniors however don’t need to look far to see the folly of such an idea.

In the first place, Medicare itself needs help. Somewhere close to 80 million baby boomers will turn 65 in the next decade and a half. America has an obligation to help these folks and give to them the honor that is due. At MedicareNational.com, we applaud older Americans and believe it is the duty of younger Americans to sacrifice and give, so that you can be cared for.

If you have worked hard to buy a Cadillac to enjoy in your retirement, nobody has a right to sell your Caddy so everyone in the neighborhood can have a bicycle.

If you are mad at politicians who want to take away what you have earned, we don’t blame you. We believe your anger is justified.