Tag Archives: Medicaid fraud

Colorado Medicaid errors far exceed commercial insurers’

Look forward to more costly errors at the expense of your tax dollars.  The new health control legislation (HR 3590) expands Medicaid eligibility. Linda Gorman points out that Colorado Medicaid’s error rate in paying claims is much higher than private insurers. Her reference is the 2009 State of Colorado Statewide SIngle Audit.  The section of Medicaid starts on page. 217.

See also: Medicare & Medicaid fraud far exceeds insurance company profits.

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Filed under Colorado health care, Medicaid/Medicare/SCHIP

Medicaid: poor care, rampant fraud

From a former senior official at the Center for Medicare and Medicaid Services, published last week in the Wall Street Journal:

Accumulating medical data shows that Medicaid recipients’ poor health outcomes aren’t just a function of their underlying medical problems, but a more direct consequence of the program’s shortcomings. Take the treatment of serious heart conditions, which are among the most closely evaluated Medicaid services.

One study published in the Journal of the American College of Cardiology (2005) found that Medicaid patients were almost 50% more likely to die after coronary artery bypass surgery than patients with private coverage or Medicare. …

Another study in the journal Ethnicity and Disease (2006) showed that elderly Medicaid patients with unstable angina had worse care, partly because they were less likely to get timely interventions or be treated at higher quality hospitals. Three other recent studies showed that Medicaid patients presenting with heart attacks or unstable angina received cardiac catheterization less often than Medicare or private paying patients. …

States expand enrollment in order to qualify for more federal aid. Insurance coverage has become the end itself, with states spreading resources widely but thinly — without enough attention to the quality of care, accessibility, or whether coverage was actually improving health. States have no obligation to rigorously measure health outcomes in order to qualify for more federal money. …

There’s also a fair degree of fraud in the program. James Mehmet, New York’s former chief Medicaid investigator, was quoted in the New York Times as believing that at least 10% of state Medicaid dollars were spent on fraudulent claims, while 20% or 30% more was siphoned off by what he termed “abuse.”

(via the Galen Institute)

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Filed under coverage isn't care, Medicaid/Medicare/SCHIP