This article is about fraud in Medicare, the American version of the NHS. The details are different, the result is the same, the fraud is humungous. $45 billion is an estimate. It is also enough to make several people seriously rich.
http://www.forbes.com/sites/aroy/2011/03/22/the-multimillion-dollar-medicaid-ambulette-scam/
““The government gives [patients] the right to go anywhere authorized,” Demoz told The Post. “If they, say, go to the supermarket, guess what? I don’t know. I’m a doctor. . . . I’m just doing my job, and my job is to take care of patients.”
The feds recently raided the third-ranked ambulette chaser, another
storefront clinic, accusing it of “colluding with ambulette provider
Majestic Transportation, which took in $3.45 million from Mediciaid in
2009, to milk the system.” In total, New York State spends over $200
million a year on ambulette services: paying as much as three times
normal cab fare, often for people who are perfectly capable of walking
or taking public transportation.
These multimillion-dollar figures may not sound like much, when you
consider that we spend $450 billion a year on Medicaid. But these are
not isolated instances of fraud: indeed, they are symptomatic of a
widespread problem that is estimated to cost taxpayers $45 billion
annually. And that’s just Medicaid; the government estimates that
Medicare is subject to an additional $60-100 billion a year in fraud.
But don’t worry—it’s all good. We can solve all of Medicaid’s
problems by spending more money.
UPDATE 1: I linked to it above, but just to be explicit, this 2005
exposé in the New York Times delves in great detail into the ambulette
scam. Here’s one excerpt:
“With an immense public transit system and fleets of taxis and car
services, New York is one of the nation’s easiest cities to get around
in, even for the old and the sick. But instead of reimbursing patients
for a $2 bus ride to their doctor’s office, or a $10 fare for a car
service, Medicaid typically pays $25 or $31 each way for these rides,
and it adds up.
New York Medicaid paid far more than any other state to get patients to hospitals and doctor’s appointments: $316 million in 2003. The state accounts for about 15 percent of all the nonemergency Medicaid transportation spending in the country, according to a 2001 report by the Community Transportation Association of America, and spends more than the next three states – California, New Jersey and Florida – combined.
The largest chunk of the $316 million spent on transportation went to
some 450 ambulette services, about a fifth of which are clustered in
Brooklyn.
And much of that spending appears to be entirely unnecessary.
That was clear on a recent afternoon in southern Brooklyn, when an
elderly woman strolled out of a doctor’s office and clambered into the
front seat of a van owned by M. J. Trans Corporation, a medical
transport company that billed Medicaid for more than $2 million last
year. After a 25-minute ride across the borough, she got out in front
of her apartment, again without help, and walked inside.
The van is called an ambulette, and Medicaid is supposed to pay for it
only when a patient cannot walk without help or requires a wheelchair.
In fact, the state refers to the service as an “invalid coach.” But on
three days spent following M. J. vans over several months, a Times
reporter found that almost all of the company’s passengers walked
easily, without assistance. The pattern was repeated as recently as
last month.
UPDATE 2: Aaron Carroll takes issue with my snarky conclusion about
spending more money. Here’s his main point:
“I (and other) members of the “spend more money brigade” don’t believe that the solution to all health policy problems is to spend more money. I believe the solution to the fraud problem is to invest in fraud prevention. I believe that the solution to the doctor under-reimbursement problem is to spend more money to pay doctors more. But there are lots of areas of Medicaid where we could spend less. But when someone wants to do that, it’s rationing and death panels.
Fair enough. Snarkiness tends to be unfair and oversimplifying, and I
accept that criticism of my concluding sentence. I guess what I’m
trying to say is, it’s disrespectful to taxpayers to not fully tackle
the issue of fraud before dramatically expanding the program. We
should, first and foremost, make an effort to spend wisely the money
we have already allocated to Medicaid, before demanding that
overburdened taxpayers fork over even more.
Secondly, Aaron’s suggestion that we increase our “investing in fraud
prevention” sounds reasonable on the surface. But it’s not that
simple. Government insurers are fundamentally unlike private insurers,
who have an economic incentive to eliminate fraud. If you want to
prevent fraud, you have to have a system in which the issuers of
insurance have an economic incentive to prevent it. You can hire more
detectives, but fraudsters are clever about hiding fraudulent billing
amidst legitimate spending. The way Medicaid is legally structured
makes it difficult to root out the problem.
UPDATE 3: I received a letter from a lawyer for Great Ambulette
Service Inc., of Brooklyn, objecting to the use of an image from their
web site. The letter states that the image “will result in immediate
and irreparable harm to our client’s business reputation” and demands
“a full retraction and apology” for doing so. I hereby apologize to
Great Ambulette Service Inc. for using their image without their
permission, and, as you can see, have taken down the image. However, I
stand by the textual content of my article, and the facts and opinions
contained therein.
http://www.forbes.com/sites/aroy/2011/03/22/the-multimillion-dollar-medicaid-ambulette-scam/
UNQUOTE
Is the NHS de facto corruption? A lot of parasites make livings out of it. Some
make very handsome livings. The boss is a communist; a very bad sign.