4 ms·
No - but $2.7B in fraud over $4.5T total healthcare spending per year is peanuts. This appears to happen over ~5 years or more - so that's $2.7B vs $22.5T or a
by onlyrealcuzzo 2y ago
No - but $2.7B in fraud over $4.5T total healthcare spending per year is peanuts.
This appears to happen over ~5 years or more - so that's $2.7B vs $22.5T or about 0.012% of total spending.
The reason healthcare is broken in the US is not because of fraud.
It's due to the design.
By the way, fraud is inevitable.
We might be able to save about ~1% per year on healthcare if fraud was reduced to more reasonable levels. That's not going to move the needle at all.
- vkou 2y agoThe design of the system makes normal billing practice indistinguishable from fraud. I will go as far as to say that charging $200 for a Tylenol, bundled with a million other different line items in a treatment is fraud.
- Terr_ 2y agoIt's only fraud when the victim isn't an individual patient. /s
- samt 2y agoYes. As usual the worst fraud is completely legal and right there for all to see.
- Suppafly 2y ago>I will go as far as to say that charging $200 for a Tylenol That's a common example but that's not actually what happens at all.
- Aloisius 2y agoIt’s not like this is the only fraud we’ve found in years. It’s not even the first billion dollar fraud incident case this year. The FBI estimates fraud accounts for upwards of 10% of healthcare expenditures.
- WarOnPrivacy 2y ago> The FBI estimates fraud accounts for upwards of 10% of healthcare expenditures. One of my clients had their business roped into a multi-million dollar medicaid fraud scheme. The FBI eventually handled it but it months and a lot of work to get the feds interested.
- rqtwteye 2y agoI would argue the whole system is fraudulent and highly corrupt but profitable so it's ok. Insurances reject legitimate claims, hospitals charge exorbitant rates for procedures that never happened and much more. Look at what PBMs do.
- jandrese 2y agoThis was one case, and it's not the first time someone went and just checked for the most blatantly suspicious case and discovered fraud. It is safe to say there is a lot more going on that is being perpetrated by people with better opsec.
- anamax 2y agoMedicare spends around $1T/year and the fraud estimates are $60B-90/year. If medicare is representative, fraud is 5-10% of total spend. https://www.aging.senate.gov/press-releases/lawmakers-join-all-out-push-to-combat-medicare-fraud https://www.aging.senate.gov/press-releases/lawmakers-join-a...
- dragonwriter 2y agoThe other big national health program, Medicaid, is pretty similar scale and pretty similar proportion of fraud.
- onlyrealcuzzo 2y agoEstimates for France, the UK, and Canada are around ~6%. Fraud is inevitable.
- Suppafly 2y agoHonestly I'd assume medicare fraud might not be representative. It's kinda big risk/ big reward because the govt has the power to imprison you, but other insurance companies would just stop dealing with you if you rip them off enough and still sue you to get their money back.
- nerdponx 2y agoYeah but that tiny % of healthcare spending is enough to fund a lot of other stuff. Don't get thrown off by the orders of magnitude: a small fraction of a big number is still a big number. Imagine what $2.7B could do for transit or housing or relocating migrants or student loan debt relief or wildland firefighter pay raises or invasive species remediation. Hell, imagine what even 1% of $2.7B could do for independent journalism or the arts.