Fraud in Medicare/Medicaid vs Private Insurance?

When it comes to the health insurance/healthcare debate I fall somewhere in the middle, personally I would favor a universal system that covers catastrophic illnesses like cancer, stroke, etc., and private insurance, albeit no for profit companies (personally don’t believe having a health insurance company publicly traded as logical), for the rest (also fine with Medicare/Medicaid).

One of the things that I started thinking about was that if we go to a MFA system I would have to think that the ability to game the system would increase exponentially. How the heck is the government going to verify every single medical claim that it receives? It would seem like that fraud would have the potential to skyrocket. I was wondering what others here thought about that?

Medicaid and Medicare fraud are a big problem. I would be willing to accept a bigger budget for the doj to investigate such crime if Medicare For all who want it comes about.


After giving it some thought, it would seem that a MFA type system would be ripe for fraud, especially in communities with heavy illegal immigrant populations. Unless you are going give everyone who is currently here and who gets here illegally a social security card how the heck are going to disprove claims from offices saying that they have treated hundreds of people who are here illegally?

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It would also call into question any estimates on the actual costs of MFA. Also how would you factor in the costs of providing MFA for everyone who gets here illegally?

Fraud is huge in private insurance too, not convinced there is much difference

You don’t allow people without proof of permanent residency to have it?

I’ve read that too. The thing is that there are two mains types of fraud. One type of being is fraud from legal healthcare providers that insurance companies have legal relationships with in which they will present charges for healthcare not actually provided. The other being from phony healthcare providers. Not sure which of those is more prevalent?

Regarding how they compare with Medicare/Medicaid in this situation I haven’t been able to find out thus far. I just see that an MFA system would be much more open for such practices.

What would exactly constitute as “disproof” of permanent residency for anyone here illegally, especially if they have just been in the country for a few days or weeks?

Greencard identification number, social security number

I thought this thread would get more traction?

You’re not going to cover illegals?

It’s too hard to look up and filter information on LOL.

No i don’t want medical insurance travel. No illegals no tourists.

The astonishing efficiency, of course, raises the question of whether Medicare is simply tunneling money out the door as fast as it can. Some fraud is inevitable – even a rate of 0.1% is enough to make headlines when $600 billion is being spent. It’s also possible that people can game the system without committing outright fraud. But Medicare has multiple layers of protection against fraud that the insurance companies
don’t and perhaps can’t match because they lack Medicare’s scale.

The DHHS’s inspector general is also on the prowl to protect the Medicare checkbook. It reported recovering $1.2 billion last year through Medicare and Medicaid audits and investigations (though the recovered funds had probably been doled out over several fiscal years). The inspector general’s work is
supplemented by a separate, multiagency federal health-care-fraud task force, which brings criminal charges against fraudsters and issues regular press releases claiming billions more in recoveries.

This does not mean the system is airtight. If anything, all that recovery activity suggests fallibility, even as it suggests more buttoned-up operations than those run by private insurers, whose payment systems are
notoriously erratic.

I wouldn’t worry too much.

It isn’t the patient that commits the fraud in most cases. It is usually the provider that accounts for the largest amount of fraud.

I remember reading fraud as a percentage of expenditures was similar between public and private insurance. I’ll have to try and find that source.

Maybe if they weren’t investigating opposing political parties//Trump, the money would be there.

That would not surprise me at all. I just don’t see it as an issue worthy of swaying one’s opinion of the matter. I don’t think differences will be significant enough when comparing the two.

Then it’s not Medicare “for all”.