Medicare

Medicaid is the largest source of funding for medical and health-related services for people with limited income. The average number of Medicaid enrollees in 2003 was estimated to be about 41.9 million, the largest group being children (19.3 million or 46 percent). In 2001, 12.5 percent of the population was enrolled in the Medicaid program (CMM, 2006). Medicaid, the federal program covering the destitute, is also riddled with problems. It serves 39 million people and the bill exceeds $141 billion annually (Korcok,1997). Medicare is a federal program for the elderly and certain disabled (Leiyu & Singh, 2004) and it covers hospital insurance as well as medication coverage for these patients. It covers 38 million elderly and disabled Americans, and paid out almost 700 million claims worth $192 billion in 1994 (Korcok,1997). Both programs are very beneficial to societal health, but there are always the sour apples who abuse the system and turn such programs into scandalous, fraudulent programs. Medicare and Medicaid are scandalous programs from which many hospitals, providers, private firms, and suppliers benefit more than the patients themselves.

Legislators say that Medicare fraud in the U.S. costs $50 million per day (Korcok,1997). Thousands of Medicare patients visit hospitals and physician offices per day and only a handful actually receive the full treatment that is seen on the billing paper. Many hospitals and private practice’s take advantage of the Medicare system and bill Medicare patients for tests that were not done and in some cases not even needed. Or some hospitals/firms overcharge Medicare for medical supplies and equipment. Medicare pays 86 cents for a gauze pad that costs another government agency 4 cents, and $186 for a home blood testing device that is widely available for less than $50 (Korcok, 1997). There were also overcharging and improper referrals, and even payoffs for providing the names of new HMO enrollees. Such abuse leads to budget deficit problems and brings about a negative image of the programs.

The programs are perfect targets for the fraudulent firms, providers, and suppliers to swindle money because the programs are fragmented and not well supervised. Although only about 8% of all providers and suppliers for medical products actually commit fraud, the totals have surmounted billions over the last five years. Investigators say that more than 4600 hospitals have illegally billed Medicare separately for outpatient services that should have been covered by inpatient reimbursements (Korcok, 1997).

The U.S. government, in past years, has invested almost $600 million dollars to help fund Medicare/Medicaid antifraud initiatives all over the country. The current Bush administration has claimed the Medicare/Medicaid programs to be a waste of government spending due to such fraudulent acts which have not been resolved. The administration proposed budget cuts of $36 billion for Medicare and about nearly $5 billion in Medicaid spending (Crutsinger,2006). Scandalous acts and money fraud within the Medicare/Medicaid system have led to such cuts in the budget and now there is less money too be swindled, but this will not stop such acts from being committed. ABC Home Health Care (America’s largest privately held home health-services company), who charged Medicare $84 341 for gourmet popcorn for parties and “conferences,” $27 930 for ABC umbrellas, and over $1 million for liquor, lease payments for their son’s

BMW, maid services and utility fees for their personal ocean-front condo. In all, ABC was charged with submitting $14 million (Korcok, 1997).

Medicare and Medicaid have been paying bills for many luxuries and without more intense fraud protection and surveillance, the program is on its way to being phased out. Although this would be devastating loss to the citizens who need such healthcare benefits, it would allow more money for a more organized fraud-proof system to be initiated and implemented.

As beneficial as the Medicare/Medicaid system has been to the citizens of the United States, there are many drawbacks to the whole program which prevent it from being a successful one. It seems that those who are covered by it are complaining and those who are forced to accept it are complaining. Those who are under it feel they need more benefits and coverage because they are the ones who need the additional help and money. Those physicians and hospitals who are accepting are complaining because the immense paperwork and restrictions that are placed on them while treating a patient. The government is complaining because taxpayer’s money is being taken from them without anyone really regulating how or when or where. The medical providers and suppliers are the only people who are really not complaining because the program is still functioning and they are making away with thousands extra in