Eons: View message "Medicare Fraud " in Medicare Insurance Group

Message 13 of 29

Medicare Fraud

I saw the post regarding Medicaid Fraud..and it made me think of Medicare Fraud. I am in the industry and worked with Medicare reimbursement. The tangle that Medicare is now is unbelievable. I was working to reimburse claims that we should have paid and Medicare did. Many(at least 65%) of these we did recieve for 10 years past the original claim. If Medicare isn't any better than that at recieving accounts payable, how is the rest being runs. Frequently we would come across providers frauding Medicare, mostly in the DME (medical equipment) catagory. What scares me most is the possiblilty of national health care when it can not even run this portion close to efficiently.

posted by kitnip45

I have been on the receiving end of Medicare payments for almost 13 years and virtually all of my claims have been handled fairly and promptly. I am a retired claims adjuster and tried to do the same for the persons I was involved with for almost 30 years.
My Wife and I have been involved with Medicare Advantage plans for past 5 years which is a separate entity from original Medicare and they have been very efficient.
Sure there is fraud and if we see any sign of fraud with our own providers, we should advise Medicare accordingly.
All of our Medicare providers know how to get the maximum from Medicare which is to be expected.
Medicare drug plan has been run fairly efficiently with some bumps in the road at the onset.
Health insurance provided by out politicians is bound to be cumbersome at times but all in all, most persons in my age groups (65 plus) are reasonably satisfied.
The biggest problem seems to be we are all involved with Medicare on out 65th birthday and we have no real education or experience with Medicare unless we became involved via our parents. The Medicare handbook is the virtual Bible with respect to the Medicare system BUT too many of us never take the time to read the manual that comes to us once a year.
Most persons feel basic Medicare pays everything and do not get the necessary Medicare supplements which pay for the items not paid by Medicare.