In a joint effort between the Department of Justice and the Department of Health and Human Services, the force of attack of Medicare executed a takedown nationwide participating load of approximately 300 defendants – including doctors, nurses, physiotherapists, pharmacists and health care providers at home – in schemes involving more than $ 900 million in fraudulent billings.
is milking your doctor your insurance company?
seems as if some doctors can be milked best for their patients insured by the research suggests. In fact, a recent study published in Archives of Internal Medicine suggests that more than $ 750 million cost health care in the United States represents annually waste, including approximately $ 200 billion in overtreatment.
Data 2013 insurance claims, which included about 1.5 million adults with commercial insurance, showed that a little less than eight percent of people had received “the low-value services “, which means they provide little value for patients who received all costs and alternatives. Medical services can include hormonal analyzes, X-rays or magnetic resonance imaging for low back pain and brain for sore head nonthreatening scanners, the study suggests.
“The warning is important to note that you are only looking at 28 services. We are thinking of a very small part, but it can give you a lens on the biggest problem” said Rachel Reid, lead author and researcher at RAND Corporation policies for CNN.
In a previous report published in National Academy of Sciences – Engineering – Medicine , a study found that the US spends more on health than any other nation. In 2009, health care costs reached $ 2.5 billion, almost 17 percent of GDP. Yet, despite this spending, health outcomes in the US are considerably lower than those of other countries.
Where does the money go?
According to the study Reid was spent $ 12.1 million in spinal injections for pain in the lower back, $ 3.6 million for exploration and $ 3.1 million for headaches and imaging for low back pain – every part of the total of $ 32.8 billion in wasted dollars of health care.
It was also found that low value spending was lower among patients who were older, male, black or Asian, low income or enrolled in health plans with high deductible.
However, doctors are really to blame?
What happens when a patient asks a specific test? If they refuse a doctor? “What am I supposed to say – no” says Dr. Jane Orient, executive director of the American Association of Physicians and Surgeons, told CNN.
“ The lack of diagnosis is one of the most common reasons for filing a demand, so there is a lot of pressure [on doctors], if you think of something to do, “according to Dr. East.
attack demolition force
Meanwhile, Medicare accused by several crimes related to fraud medical care, including conspiracy to commit health care fraud, violations of the anti-kickback, money laundering and aggravated identity theft statutes.
“As this demolition should make clear, health care fraud is not an abstract rape or benign crime – is a serious crime,” said Attorney General Lynch according to News Justice . “The criminals we pursue in these operations try to use public funds for private enrichment is aimed at real people. – Many of them need significant medical care,” Lynch said. “They promise cures and effective therapies, but provide no Above all, abusing basic bond of trust between doctor and patient, between pharmacist and doctor, between taxpayers and the government -. And pervert their own purposes”
-. Katherine Marko