The Cost of Too Little Administration

People who praise government-run health care programs for their low administration costs often overlook one consequence of less oversight – payment of bills and expenses that should not have been paid. For example, the Centers for Medicare and Medicaid Services paid $4.4 million over a 4 year period for 2,657 Medicare Advantage plan enrollees who were not receiving any benefits because they were dead. The Health and Human Services Office of the Inspector General (OIG) has documented millions of dollars of improper Medicaid claims by these states:

  • Of 173 "family planning" claims (procedures that prevent or delay pregnancy or otherwise control family size) made by New York, only 3 were valid – resulting in $2.6 million in improper payments to the state.
  • Connecticut's community-based Medicaid administrative claim in 2004 was so poorly documented that the OIG was unable to determine whether the $9.3 million claim was allowable or not.
  • In Pennsylvania, the OIG was unable to say whether roughly $60 million in disproportionate share funds were used for their intended purpose at The University of Pittsburgh Medical Center and Temple University Hospital.
  • Connecticut claimed $9.4 million for drugs that may not have been allowable for Medicaid reimbursement in 2004 and 2005.
  • West Virginia claimed $2.3 million in unallowed claims for Medicaid school-based services.
  • An Indiana state-owned psychiatric hospital racked up $26.2 million in Medicaid payments even though it did not meet Federal Medicaid eligibility requirements. The federal government wants a $16.3 million refund.

Comments (5)

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  1. Joe S. says:

    Looks like a den of thieves.

  2. Rick says:

    Not a den, Joe. Call it a sea of thieves.

  3. Ron Greiner says:

    Seniors in America can now open a “free”, tax free MSA at the bank and the United States federal government will make deposits on Jan 1st of each year. The Medicare MSA option is a Medicare Advantage plan.

    I’m sure none your dead Medicare fraud people were on a Medicare’s MSA Advantage plan. Traditional Medicare has fraud as well. I don’t think we should be attacking Medicare Advantage right now because that’s President Obama’s job.

    Traditional Medicare has a deductible then only pays 80% of hospital and doctor charges. Medicare’s MSA plan pays 100% after the deductible. That’s big savings to a senior with a $100,000 heart attack.

    Has anybody has ever seen a newspaper story on Medicare’s tax free MSA option? I have been searching and still can’t find one. Maybe the father of MSAs knows the answer to that question.

    Why would a controlled media censor Medicare’s tax free MSA?

  4. Don Winslow says:

    Interestingly, the Feds identified some fraud and tried to correct the problem.

    Are you saying there is no fraud in the private insurance sector, or greed or whatever else these boys/girls do to generate obscene salaries and benefits for themselves? Regards.

  5. Joseph Hepp says:

    Reply to Ron Greiner:

    I just spoke to Advantra, the only company that offers an MSA in California. The plan is not offered in my zip code, and it will be dropped next year according to the agent I spoke to. Apparently Obama wants to go in a different direction. I can join an HMO at no cost and great expense to Medicare for many years. I will not derive any benefit except for regular checkups, since I am cursed with excellent health. An MSA would be much less costly to Medicare, and provide better benefits to me.

    Does anyone have any information about why such a good plan will be suspended?