Looking to help an immigrant senior secure health coverage until he becomes eligible for medicare.

Lets say you reported insurance fraud to an insurance company, such as Medicare, and they choose to ignore it or not take your claim seriously, even with hard evidence, where can you report them? Or where else can you take your claim?

Also, as a side note, where can you report a doctors office, or a doctor, for misuing his authority to prescribe drugs? And even after talking with him, he doesn’t stop, or doesn’t take your reports seriously?

I just saw a news item that said little kids, I’m talking 4 yrs. old, were being subjected to root canals. In one case, it was 16 root canals in one session. This was all to get money out of medicare. Why aren’t they being prosecuted for child abuse (torture) as well as fraud? I can’t stop thinking about this, and I can’t stop crying. What kind of monster would do this to a child?

Let’s just say that doing nothing is not an option. OK

And that Obama-Care is a crappy option that will be hugely expensive, that will steal people’s Medicare Trust Fund, and that will only make a small dent in the problem of the Uninsured.

OK — those are just assumptions for the sake of argument, they are not final conclusions, they are just set up for my question, which is "What Could the Government fo Instead of Obama-Care?"

Here are some possibilities:

1. Very small Federal primary care clinics staffed by 3 or 4 doctors and supervised on a monthly basis by ultra-highly qualified doctors who visit every month or so to make sure the primary care is good or very good. These clinics would be operated on a "Good Samaritan" basis, and on a "Sovereign Immunity" basis, so if mistakes were made the Federal government could not be sued. It could however pay fair and reasonable compensation for gross negligence by the doctors it hired and supervised. Fair and reasonable would be decided by a formula, and by a panel of expert supervising physicians. So these primary care clinics would operated in a limited liability zone — not subject to local state jury trials for medical malpractice, and all patients seeking care in such clinics would have to knowingly sign a waiver of their right to sue. No waiver, no care, back out on the street, no Good Samaritan here to save you, try County General.

These little clinics should number about 10,000. They should basically be in the business of taking the primary care load off emergency rooms. They should do preventative medicine, and help clients get further care as needed. So your basic heart pills, and diabetes pills, and athsma treatments don’t have to be done for 00 in a busy emergecy room, they can be done for in a micro-clinic run by the Federal government. That’s a savings of 5 for each patient. Figure 20 patients a day, 300 days a year, pretty soon you’re talking real money (like 0,000 per year saved for each doctor on the staff). You could actually pay the doctors pretty well out of that saved amount, right? Let’s say 0,000 per year starting salary. You still clear 0,000 of societal savings for each doctor working.

This is all based on the idea that if the government wants there to be more healthcare, it should "just do it"

If the government wants the leaves raked off the White House lawn, it should "just do it"

The doing concept only seems strange in a world where the government has gotten used to writing 16,000 pages of detailed commands and instructions for anything it wants done — so that other people can do it.

I say skip the paperwork — if you want something done — do it! The Doing Concept, part of what made America great.

How about this idea for a second concept: Let the VA Pharmacy fill prescriptions for Vets based on the orders of the Vets’ own doctors, so long as those doctors are: (1) Board Certified (2) America Educated and (3) in Good standing as Physicians (their licenses are fully in operational and valid and current). So there’s no reason whatsoever to imagine that the Vets own doctor is not good enough to write the prescription. OK — then just fill it! It’s like the Just Do It concept.

Don’t fuss, don’t make the vet get a whole new doctor and come into your system, just let them have the benefit of government buying power, so the meds go out to the vet at about 20% of retail which is what the VA pays for them. The VA can charge for postage too.

Again this would be on a "Sovereign Immunity" "Malpractice Waiver" basis so the U.S. government would take no legal risk in this program. No chance of being sued. Fraud is still possible, but liability from lawsuits is not. The fraud can be squeezed out of the system by investigation and relentless prosecution of malfeasors — bad doctors who use their position to cheat Uncle Sam.

These are just two ideas. My basic idea is to take the problem down by layers, starting with the easy layers. More primary care — do it. More meds at fair prices — do it.

It’s the Doing Concept.

Over time this will make the problem smaller. Not vanish — but smaller. Instead of 45 million uninsurables — maybe in 10 years just 25 million. That’s way better than Obama-Care is likely to do. And at 10% of the cost of Obama-Care. And without stealing the Medicare Trust Fund.

It’s better policy because it’s a better value. It impacts the problem at low cost and low risk by using "doing" instead of "commanding" as its method of proceeding. Raking the leaves up, instead of writing a 16,000 page set of commands to get the leaves raked up. Doing — wow there’s a thought!
I have never watched FOX News. I have never read any FOX publication. I never listen to FOX radio.

Any resemblance between anything I say, and anything said on FOX is either coincidental or it arises from FOX people reading my posts (here and elsewhere) picking up the ideas, and making media talk with my ideas, without giving me credit for them, which I don’t mind. I’m with Rabidranath Tagore, the Indian poet, when he said, "Whatever isn’t given … is lost!" So pick my brain,, pick my bones .. it’s all given freely. But it is irritating when people think I get my ideas from FOX. It’s really unjust — a bad rap. The next person who says that should include a quote from FOX that is the paraphrase of what I say in my posts. You have to show that they said it first, then I said it second. Otherwise, I couldn’t possibly be getting my stuff from FOX, you see that, right? Just bring the quotes, or stop the bad rap. Thanks.

America has been socialist for over a hundred years. We are more socialist then communist China. We take care of our workers, children, senior citizens better. We do a better job of protecting the environment from corporations. We spend billions on social programs. We guarantee public education for the masses, subsidize state owned universities with taxes, spend millions on subsidized loans for students. We got social security, medicare, medicaid, the GI Bill, unemployment insurance, labor rights, laws against corporate fraud, etc, etc. The list goes on.

What reality are you cons living in?
Northern Europeans countries like Denmark, Holland, and Switzerland have some of the highest living standards in the world.

On the far right of the spectrum, you got the backward countries of the middle east. Why is it the most religious and most conservative countries the crappiest places to live in?
To the guy denying America is socialist..

If Democrats are socialists, then America is in fact socialist and only becoming more socialist with every generation. When you have government own schools and universities and government run programs whose purpose is not profit, but the benefit of the people, then said organization/program is socialist. It is owned by the people and run for the benefit of the people.

I recently attended a consultation with my two sisters and mother with my Mom’s oncology team: seems there is a gene that she carries that could be hereditary, which would elevate our risk of cancer. Anyway, Four of us were present for this "consult"… no clinical work of any kind.
A couple weeks later I received a notice from my insurance company. The Oncology practice billed all three of our insurance companies, and medicare (mom) for a total of 24.00, for a "consultation" which lasted barely 45 minutes. I feel this is an outright abuse of the system. To what entity can I report this?

why doesn’t he just cut the waste and fraud from Medicare and keep that plan? We seniors like Medicare.
The plan he has will drive us trillions more in debt. He is pretty tricky with his words.
Obama said this..sorry guys.

Having worked in law enforcement and the medical field I know what to do..but thanks for the advice and my hearing is just fine and so is my eyesight..
Thank God I did not vote for this man. I am in agreement with the congressman that spoke out at obamas joint session speech.
You know, lack of respect makes parents look BAD.
YA YA thats true what he says illegals will not receive benefits….BUT…HE IS GOING TO CIRCUMVENT THAT BY LEGALIZING THEM!!! DIG IT???????

HE LIES AND IS VERY DECEITFUL AND HAS NO QUALMES ABOUT IT!
ANOTHER LITTLE ITEM JOE WILSON WAS A MARINE FOR 30 YEARS AND HE HAS FOUR SONS THAT ARE NOW SERVING IN THE MARINES..
MARINES TAKE NO BS. HE DESERVES A MEDAL …APOLOGIZE TO ANYONE…NO WAY.

at this very moment. And given the general acceptance the fraud has been ongoing for YEARS. Wouldn’t it be prudent to say that the government CANNOT be trusted to run Nationalized Health Care without multibillion dollars worth of fraud in the future?

This is in continuence to a question I posted earlier:
(How do you "squeeze" 35 billion from a system (Medicare)that is going bankrupt? )

With ALL of this in mind would you agree that if the fraud were stopped YEARS ago we probably wouldn’t be in such a state of "crisis" at this time.

So why would we believe politicians, who will by all measures be history in a few years, to create yet ANOTHER Socialized system that has the potential for even greater fraud.

Why can they NOT fix the problem they’ve helped to create over the years? Why are they attempting to add another?
Why will my kids live in poverty the rest of their lives to pay off a debt to a communistic country that we’ve borrowed money from to continue the fraud and debauchery of our politicians?

http://www.cms.hhs.gov/ActuarialStudies/downloads/MedicaidReport2008.pdf

http://www.cms.hhs.gov/ReportsTrustFunds/

http://www.actuary.org/pdf/socialsecurity/ss_future.pdf

Using the Yahoo backbone the passport, drivers license, medicare card, birth certificate,bank information was being used to change the ID of my child. The Australian Commonwealth, has used its vast power to support this identification abuse and fraud and now that they have been caught doing it by using pen registers and other sniffing techniques they are running for cover of diplomatic immunity. Hey the ID work was so good that I have on record the Australian Police asking what I am doing with someones passport. They had no idea that the cyber was on the computer of a three year old, which was in 10 county court, Parkwood, QLD, in the house of a Gold Coast City council water department employees houe. This guy was then reported to the police in Southport as having recieved a change of ID fraud with some NSW people. Can you imagine this? The police have decide to do nothing!!! The goverment is complict in kidnap. Do you think that a KIDNAP should reamin uninvestigated.

l asked about this company before and it went into community while l was dozing. l lost the opportunity to thank the agent who warned me they "sometimes" use deceptive practices.

The company is WellCare/Coordinated Care Plans. They sure did on me. They sent a "new, inexperienced" rep "who couldn’t answer our questions, would find out" "but why don’t we just sign since she’s here?" "she’ll be sure to get back to us" Oh yea!!!

So l just found out l will lose Medicare coverage on July 1, OR
my excellent physicians, OR pay them out-of-pocket + pay Medicare premiums!!!

l am SO angry.
l tried to opt out over phone. They won’t speak to you unless you can provide an I.D. #. . Not way. Ditto email.
SO YOU CAN’T CANCEL until you get an ID #, which of course will come only AFTER medicare discontinues.

DECEPTIVE or what?
And this is aimed at an aged and disabled population with enough troubles already.

SO WHERE DO l REPORT THIS besides Medicare (already done)?

then why doesn't he fix the fraud and abuse that he admits are in medicare and medicaid, before offering another massive program ?

I really don't agree with either program unless they can be revamped and only go to those who truly need it but like any government program both are full of fraud and mishandling but I digress.

Anyway why would he cut one and increase the other? Could it have something to do with one is predominately single women with young children (Medicaid) and the other is predominately senior citizens (Medicare)?

What kind of message is this sending to the older generation?

Actually I am surprised that AARP is not all over this one, never mind, I forgot it is primarily a liberal organization.
I have seen people on medicaid that don't need it because there job offers health insurance but they don't want to spend any money on it so they oft for the free government assistance.

I hear politicans saying things like "most people are happy with medicare" when pushing for Universal healthcare.

Medicare is going to be bankrupt within the very near future. Medicare spends hundreds of billionis a year and studies have shown around 44% of that money is fraudulant in terms of people billing for no services just to pocket money. Though I'm not on it I've also heard old people say they aren't happy with it, it doesnt' cover many things.

How can they say this is a good model when tens of billions of dollars a year go to fraud, and its going to be bankrupt? This is getting off on another topic but what has the governmetn run effectively? Certainly not social secuirity or medicare?
Jake, you didn't address any of the issues I brought up, you just disagreed with me. Typical liberal argument.
Peggy, another typical lib. If your solution isn't the best one then well there isn't any other. Romney has everyone in his state getting healthcare, there's less fraud, people are happy with it and its not going bankrupt. There are other solutions than your liberal solutions.

A History Lesson:

1. In 1913, thinking it was being overcharged by the steel companies for armor plate for warships, the federal government decided to build its own plant. It estimated that a plant with a 10,000-ton annual capacity could produce armor plate for only 70% of what the steel companies charged.

When the plant was finally finished, however — three years after World War I had ended — it was millions over budget and able to produce armor plate only at twice what the steel companies charged. It produced one batch and then shut down, never to reopen.

2. Or take Medicare. Other than the source of its premiums, Medicare is no different, economically, than a regular health-insurance company. But unlike, say, UnitedHealthcare, it is a bureaucracy-beclotted nightmare, riven with waste and fraud. Last year the Government Accountability Office estimated that no less than one-third of all Medicare disbursements for durable medical equipment, such as wheelchairs and hospital beds, were improper or fraudulent. Medicare was so lax in its oversight that it was approving orthopedic shoes for amputees.

3. When the federal government nationalized the phone system in 1917, justifying it as a wartime measure that would lower costs, it turned it over to the Post Office to run. (The process was called "postalization," a word that should send shivers down the back of any believer in free markets.) But despite the promise of lower prices, practically the first thing the Post Office did when it took over was . . . raise prices.

I provide insurance for my daughter who i dont have custody of. I recently found out that her mother has never used the insurance. I am most certain she is using state medicare insurance for her. I have proof she has received the insurance card with signature.
Is this grounds to persue insurance fraud on her mother? If so what are the consequences of this?
OOPS lol Medicaid!

Right now, there is a lot of fraud for billing insurance companies, medicaid, and medicare for procedures that were not done or were not needed. Insurance companies spend 20-30% of their revenue making sure the procedures ordered are valid.

If all medical professionals were on a fair plan of compensation instead of making a profit from procedures that they billed the incentive to commit fraud or order unnecessary procedures would be totally eliminated, wouldn't it?

Then, evaluate them and compensate them on whether they are making their patients healthier or not.

Doesn't this make sense?
Vastright, I used medicaid and medicare in my example. The problem is in the way people are compensated. We use private doctors to run a government funded program and they abuse it. If they were salaried government workers they would have no what of profiting from cheating.
Medicaid and medicare are the most efficient health care programs we have. But they are still subject to abuse for the reasons I have given.

Mom says that about one-third of Medicare, for instance, is overcharges and fraud that the U.S. Congress approves. Our government is a huge wasteful, out-of-touch bunch of crooks, says mom. I believe mom, she knows what is going on.

I would like to know if anyone can help me with this.I believe this local chiropractor is committing illegal acts/possible ins. fraud,etc & since he preaches that he is a Christian chiropractor & religion all day long,if he is in fact committing fraud or illegal activity-I think he should be exposed.Here are things he is currently doing 1-He is the only licensed chiro on staff-he fired his Physical Therapist(PT)a few weeks ago & hired a"preacher(no joke) to assist the patients w/PT(yet he bills ins. companies for the therapies,shouldn't "he the licensed Dr. have to actually do the therapies to bill for them?")He also hired a lady who wants to be a chiro but does not have a license yet-she does all the exams,x-rays & expensive tests & HE DOES NOT take part-yet he bills the ins. company(isn't that ins. fraud?).The expensive tests are only performed on people who have ins.that covers them not on cash pts or medicare pts (theydontpay)He insists they are necessary to the ins. patients.
More details-Although the wanna be chiro lady is not allowed to do"adjustments"on patients-I have seen her put her hands on pts. when nobody else is around & the Dr. lets her "rent" out his office for her own use on the weekend so obviously she is acting like a chiro when nobody else is around. I belive she has a doctorate degree so he has people call her Dr,but she is not licensed so isn't that giving people false ideas about what she can or cannot do? Does anyone know for sure if she is allowed to be performing therapeutic tests, muscles tests, x-rays,re-exams, etc,to patients & then he is allowed to bill the ins. company for it (under his name & tax id # since obviously he cannot bill them saying she performed these services so he bills as if he did them).Also,this other guy sometimes does the muscle tests & therapies & he has NO EXPERIENCE whatsoever,isn't this all illegal?Who do I contact first about this?Besides the ins.companies?DO I contact the board of chiro,the AMA,theDA,who?
I know all of this because I worked as a secretary in this office and all of this crazy stuff started happening in recent months,I was told she was Dr. & just awaiting her chiro license & was required to call her Dr.Then another girl int he office told me she was not a licensed Dr. Then I started asking questions & not understanding if something illegal was going on & suddenly I was out of a job (loyal worker for almost 6 months-only took 1 day off ever),I was told the hours I was originally hired to work have changed & if I want to keep my job I must work 12 hours a day 3 days a week and work 8-9 hours the other 2 days & they were not willing to pay overtime (another girl who works there gets over 40 hrs. per week & does not get paid overtime-they pay her extra hrs. as abonus to "get over") Anyway,I was hired to work 30 hrs. per week-I have a child & they knew these "new" crazy hours were not possible for me so I was terminated-I think it was because I Knew too much, asking ???'s

http://www.factcheck.org/elections-2008/obamas_false_medicare_claim.html

Fact check says he isn’t telling it like it is. McCain isn’t planning to cut medicare benefits. He is wanting to make Medicare more efficient by cutting out the fraud and using electronic medical records. Obama’s approved ad is a total fabrication. Is that ok?
52 mil: That isn't even McCain talking. What does that prove. McCain nor anyone else is going to cut Medicare with the baby boomers just beginning to retire. He wants to cut the fraud and help to find ways to manage it in a more frugal way. That has to happen.
He didn't call Obama a terrorist. He questions his judgement in the people he associates with.

Read the Intelligence Report in the 2-20-08 edition of Parade Magazine. Medicare's budget is 400 billion dollars. The article says 70 billion dollars were paid out in fraudulent claims. That's 17.5%. Do you still think government run health insurance is a good idea? If the US government ran a program for everyone, what would the budget be? two trillion?
What would be the amount of fraud? 350 billion dollars if the fraud rate stays the same.

In my opinion, there was a good balance between the economy and the middle-class cost of living.

Medicare is riddled with fraud and according to many documents, Congress cannot account for much of our money spent as tax-payers.

Who else has to struggle more these days than they did several years ago?

Bill Clinton was commended for his welfare reforms even by republicans. When Ms. Clinton gets elected & she starts to implement her healthcare reforms how will she take care to purge the waste & fraud that already plauges the medicare system ?

no crap answers or I'll report them
well i think mr clinton proved his own ability to cut down on waste (first balanced budget in 70 years) . so i dont think its beyond reason that change is within reach. but still its a machine, i know.

I have the unfortunate privilege of knowing a couple that have some very questionable practices. To start, this couple has been together for over 9 years, and have 2 children. Both kids have been diagnosed with ADD,and ADHD. They collect social security for the kids disabilities which they use to fund their expensive tastes and the Wife's compulsive shopping habits. None of the money actually helps the kids. In fact the couple is not even married. The reason she said is that if they were married they would have to pay more taxes and get less money back, also medicare would not pay for the younger childs health care if they were wed. I did find out that they report to someone that the "husband" is not living with them when in fact he has for the past 9 yrs. She makes money by taking care of a mentally challenged person that is a live in. Her room is a porch. To make room for her they moved the son (10yrs.old) to an attic space(he was in the porch before) not suitable for living.
They say they are married if an application is filled out to obtain some kind of free Gov't service, credit, ect. Once she stole a new credit card from a grandparent activated it, and used it to fix her cat. With all the money they bring in from state sevices and their jobs they bring home close to 5000 grand a month and barely have food for the children, but they seem to be able to afford new vehicles every couple of months. Also, the reason they arent married is that if they were they wouldn't receive medicaid for the youngest daughter. I've been a hard worker all my life and it p's me off to see the kids in the middle. Both kids are good kids and unfortunately they are being drugged up with ritalin daily. I noticed the reason for this is that the kids want attention that the parents don't want to provide so they get drugged up to stupify them. Less than 30 min a day are spent with the kids ages 7 and 10.Even the firescape doesn't work it's falling down and made of rotted wood. help
thanks for the advice. I will put it into effect immediately. Please keep the answers coming. I will keep you updated on what happens. God Bless:)

I made a credit card purchase 1 week ago. I have received only automatted replys. Now I cannot even make inquires on my purchase. The replies stop at being approved by the sites doctor. I looked up this doctors name and a doctor with the same name is listed on a medicare fraud list. I cannot find out if this is the same doctor I am dealing with.The firm that WAS taking my inquires is:safetrustprocessing.com
Has anyone else had similar issues and can ANYONE offer suggestions?

When lard-ass was First Lady, I sent her a 235-page report on the death and mistreatment of a patient fraudulently diagnosed and treated for cancer and murdered to cover it up. This was a clear cut case of Medicare fraud and murder.

Hillary sent the report back to me, with a letter stating she would not involve herself in such matters.
Firewomen . . . yes, I did go the police and also to the FBI. The FBI concluded it was a murder and referred the case to the state, because there is no federal homicide statute. This took 8 years! Hillary could have done something much sooner. Instead, she sent the report back with an insulting letter. That letter will find its way to the press, I assure you.