[Chewbarkah]

Medicare has to process every bill and claim. Each prescription and service must be generated by a physician with valid and unique “provider number”. How hard would it be to use simple computer programs to monitor each “provider number” for prescription activity outside normal expectations for a given medical practice or specialty, then focus on the bad apples? The Obama administration can’t operate a lemonade stand, but this has been going on for decades. The government does not want to stop Medicare fraud, or it would. Every senior who has Medicare Drug Coverage is paying out the nose in higher premiums because of gross, intentional corruption.

[Carry_Okie]

How hard would it be to use simple computer programs to monitor each “provider number” for prescription activity outside normal expectations for a given medical practice or specialty, then focus on the bad apples?

I would bet that every insurance company selling healthcare coverage already uses such software. In fact, it's probably available off-the-shelf.

[upchuck]

Every senior who has Medicare Drug Coverage is paying out the nose in higher premiums because of gross, intentional corruption.

Higher premiums? Not always. For the plan I'm on, I paid $18.50/mo in 2013. I'll be paying $12.60 in 2013 for the same plan except the deductible is lower and they lowered my co-pay on Rx drugs to a dollar.

[headstamp 2]

“How hard would it be to use simple computer programs to monitor each “provider number” for prescription activity outside normal expectations for a given medical practice or specialty, then focus on the bad apples? “

You can bet if it was something akin to the credit card companies, they would be nailing these guys left and right.

The government is a plodding elephant. They can’t even get a website up and running after 3-4 years.

[ArmstedFragg]

If they stopped fraud, they wouldn’t be able to justify additional entitlement programs by promising they’d offset them by eliminating fraud. In my old neighborhood, MediCal and Medicare fraud were cottage industries, operated by primarily by folks of various eastern European ethnicities.

I once met a guy who had a job at a medical equipment store where his job consisted entirely of telling anyone who walked in and wanted to buy or rent something that they were currently out of that item. The place was just a front for fraudsters. Over a period of a couple of years it changed locations and names several times.

He had an awkward experience the first few days on the job when he tried to rent the wheelchair to someone and the boss went ballistic. He’d almost blown the whole setting.