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Audit says Utah losing millions to Medicaid fraud, waste

Audit says Utah has an outdated system for finding fraud and abuse

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  • jenny
    Aug. 22, 2009 6:25 p.m.

    Let us not be quick to blame the government but lets look at the dishonesty of the people involved. they would be dishonest even if they were not collecting from the government - the program has well meaning but humans are the cause of failure - lets look at the greed of the human -

  • Anonymous
    Aug. 22, 2009 9:37 a.m.

    As I read these comments, I'm reminded that a fiscally conservative state legislature that has for years been proud of their budget surpluses, has refused to approve Utah's Dept of Health's requested funding to update it's antiquated computer system. So an internal Audit by the State has brought to light an underfunded, understaffed and ineffecient Medicaid Fraud program. It really is true, we do reap what we sow.

    If we want a more effective use of our tax dollars, we should insist that our legislature be more aware of the results of their actions or inactions. The real fraud here is not medical providers but the state legislature that has failed to properly fund this vital service.

  • My Doctor
    Aug. 20, 2009 5:11 a.m.

    Says jhe is going to get all he can.
    The rest are doing it.
    We need this new insurance like Medicare.
    Even Medicare is paying to much for test that get no results.

  • @Chris B
    Aug. 19, 2009 7:22 p.m.

    Are not the proposals to make the greedy accountable for their indiscretions against the health of an entire nation?

  • Chris B.
    Aug. 19, 2009 7:06 p.m.

    Most liberal programs end up just as this - a bunch of money wasted. When will we start making people more accountable for themselves? Not in the next 4 years thats for sure.

  • Fair health care program
    Aug. 19, 2009 6:51 p.m.

    Liberals are always talking about "fairness". Ok, then if we are going to have a "fair" national health care program, lets make it fair. If you smoke, drink alcohol, do illegal drugs, ever get an STD, or are over weight you pay more of the tax burden! If you abuse the system (frivolous doctor visits), you pay more taxes! If you get a serious driving violation, you pay more taxes. If you are ever caught in fraud, or making false medical health claims, you lose your health care,for life! If you have an illegitiate baby or father one, you pay more taxes! That would be very fair, wouldn't it?

  • Educate yourself, waste
    Aug. 19, 2009 6:21 p.m.

    Medicaid is only available to Americans and LEGAL residents. Please stop acting like a racist.

  • waste
    Aug. 19, 2009 6:00 p.m.

    talk about waste, they give medicaid to illegal immigrants. Maybe they show not pay for them to have medical insurance and they'd have more money.

  • Several points
    Aug. 19, 2009 5:59 p.m.

    My dad always said that any government run hand-out should pay the workers according to the number of people that apply for and are denied benefits!

    How much ya wanna bet that the people bringing their kids into the emergency room for earaches because they don't have enough money for the doctor go home and have a beer and a cigarette?

    There are people that definitely need the services and I am all for that, but because it is the right thing to do.

  • Denise L.
    Aug. 19, 2009 5:34 p.m.

    For those that think the private sector insurance companies are free of fraud and abuse--think again!!! There are billions lost to fraud/abuse in commercial plans every year.

    People who just have this gut anti-government reaction to everything just don't have all of the facts. Fraud and abuse will not go away if we just have a completely private-run health care system. What are you smoking?

  • Nice
    Aug. 19, 2009 3:26 p.m.

    "150k" new employees in the recent job market would be HUGE! Two birds with one stone. Nice!

  • Eddie
    Aug. 19, 2009 2:55 p.m.

    To Common Cents: What a ignorant remark. If you think this is a partisan issue you are part of the problem. As long as people think in terms of Dem vs. Rep it will never change. This is a bureaucratic issue, not political. Only if politicians demand accountability from the bureaucrats can reform be made.

  • Sterling
    Aug. 19, 2009 2:37 p.m.

    What "Redshirt" (12:42) failed to point out, is that there is a built-in reason for private insurance to cut fraud and abuse, its called profit and competition!
    There is little or NO incentive for government to cut waste, fraud, abuse, (faceless bureaucrats,) and besides, its not THEIR money, why worry about it!!

    One report I read 2 days ago reported that it would take 150,000 NEW federal employees to "manage" Obamacare. I don't know how accurate that number is, but I'm sure it would be A LOT of employees. Then, if Obamacare is passed, and it proves to be a dismal failure, who's going to tell these 150k employees they're out of a job!

  • MEDICAL INDUSTRY FAULT
    Aug. 19, 2009 1:53 p.m.

    If the Medicare and Medicaid system was privatized, than it would not be around do to the FRAUD of the INSURANCE INDUSTRY not the government.

    All the companies that were bailed out and even Madoff investment scam was a privatised ethics problem.

    The government saved some these companies of your 401 k plans which were stolen by the privateer pirates.

    F O X N E W S reports this article and everyone is sucked in to it...

    Try looking up N L P on the web to see how you are programmed people.

    Remember IT WAS THE MEDICAL INDUSTRY THAT DID THE FRAUD, not the government.

    BLAME THE MEDICAL INDUSTRY AND THANK THE GOVERNMENT FOR FINDING OUT!!!

  • RedShirt
    Aug. 19, 2009 12:42 p.m.

    To "Silva | 3:59 a.m." and "disillusioned | 8:17 a.m." In Florida the NPR did a report titled "Medicare Fraud Acute in South Florida" where they stated that Florida loses $35 million/year to fraud in Medicare. If you do a simple search for Medicare fraud in California, there are multiple cases where small groups of people were able to get millions from the program. According to the Idaho government web site, "overpayments represented 20% of Medicare spending". In other words fraud. According to the NY Times "New York Medicaid Fraud May Reach Into Billions". Sounds like fraud is everywhere in the Medicare and probably Medicaid system.

    Fraud in private insurance companies may reach 10%, but, if Florida is an example of the amount of fraud in the Medicare system, then the government is losing 20% to fraud. If you combine that with the 25% overhead for the federal government plus the 5% overhead for Medicare, 50% of what goes into medicare is burned.

    With private insurance you have up to 20% for overhead plus profit, then 10% lost to fraud. Private insurance burn 30% of their money.

  • Anonymous 10:48 am
    Aug. 19, 2009 11:54 a.m.

    That's a pretty bold statement. Really? Doctor's offices all over are submitting claims? You've seen this first hand? Over and over again??

  • CJ3
    Aug. 19, 2009 11:31 a.m.

    I dare say that each and every one of you know someone dear on Medicare.

    The bill was drafted in large part by Repuclican John Byrnes. "When deliberations began in 1965, both AMA members and their suggestions were rejected due to unruly conduct at meetings."

    Hmm, sound familiar?

    The bill went through more than 5 amendments before being passed, and signed by Pres. Lyndon B Johnson in Independence, Missouri, and was attended by Harry S Truman.

    Johnson credited Truman with "planting the seeds of compassion and duty which have flowered into care for the sick and serenity for the fearful."

  • Anonymous
    Aug. 19, 2009 10:48 a.m.

    THe cheating and fraud is by the private sector medical folks. Doctors offices all over are submitting fraudulent claims. So where is the integrity? Not there. I'll take my chances on the government whihc is not profit motivated and will cheat the system. They may make errors, but the behavior is not as corrupt.

  • Common Cents
    Aug. 19, 2009 10:25 a.m.

    Dear Fraud and Waste, The Utah Medicaid program has been managed by REPUBLICAN appointees for the entire duration of this problem.

  • Jenn
    Aug. 19, 2009 10:11 a.m.

    thats because we as the state of utah would much rather help TWEEKERS that wanna keep having kids and live off the state rather than people that really need it!!!

  • ExMoWeHoMo
    Aug. 19, 2009 10:11 a.m.

    Government fraud is just one small drop in the bucket compared to the fraud committed in for profit private insurance.
    With so many people on this board complaining about the government, why do you keep electing the same people to office? America's in the situation we're in now because Americans are lazy, gullible and ill informed.

  • Sadly, this is true
    Aug. 19, 2009 9:48 a.m.

    After 20 years of hard work, the result being painful knee trouble, ignored as best as possible, it got so bad that I was finally able to get a voucher to see an orthopedist who was covered by Medicaid. I was thrilled that I would finally find out what the problem with my badly swollen knees was!

    Nope. After waiting only a few minutes, I was called in to see the specialist. He felt all around the afflicted joints, bent them painfully this way and that, then told me, and I quote, "That concludes this portion of the examination."

    "OK doc, what next?" I replied.

    Casually, "Nothing. You're done."

    "Wha-what do you mean I'm done?! What should I be doing for them?"

    Unbelievably, he answered, "I'm sorry sir, we don't make that determination."

    Thinking a diagnosis was to come at a follow-up..."Do I make another appointment at the desk?"

    "Nope, your done."

    I couldn't believe what I was hearing, but held my tongue as I left, thinking, Well, then what good are you!

    What a waste of resources. That was a complete waste of time.

  • To disillusioned:
    Aug. 19, 2009 9:29 a.m.

    Provide some known examples, it's hard to side with your analysis if there is no facts. I know of several people personally that do get help because of their disabilities and never had to live in a nursing facility. The bankrupt families aren't necessarily poor, they no longer have to pay their debts thus giving them a paycheck with just having to pay for basic living expenses. A state that is so Christian can get help from their churches.

  • re: Silva
    Aug. 19, 2009 9:28 a.m.

    Ya, this is only a software problem.

    Medicaid is notoriously wasteful everywhere.

    The inherent flaw with any government program is that there is ABSOLUTELY NO INCENTIVE to care about expense because you are spending someone elses money.

    The secondary issues, and we all know it happens, is if you don't spend all (or more) than what is in the budget they will reduce your budget the following year.

    This actually INCENTIVIZES spending!!

    Government is built to be wasteful and if you have an expectation otherwise we all know through years of observation that you will be disappointed.

  • Fly_on_the_wall
    Aug. 19, 2009 8:19 a.m.

    The government is full of waste and corruption? Doesn't anyone remember Enron? What about Mr. Madoff and his scheme? The private sector has more waste, corruption and greed than any government program ever dreamed of having. Come on people think before regurgitating what you hear on the TV or radio.

  • disillusioned
    Aug. 19, 2009 8:17 a.m.

    Thank you Silva, for seeing the REAL problem. This is a UTAH problem!!!!!

    The biggest problems with the Medicaid program in UT is the State Legislature, and it's state laws controlling Medicaid. Did you know that the legislature has passed statutes forcing people with disabilities to have to live in a nursing home for at least 6 months to "prove" that it's cheaper for them to receive services at home. Research already shows it is cheaper...yet the state still forces this much more expensive situation on people. Or the parents who have to give up custody of their child with a disability in UT to the state because the state refuses to cover their medical costs until they have custody, thus costing the state so much more cause now the state has to provide custodial care!!! Such abuses happen all the time in UT...and if you all in UT ever knew about the hundreds of bankrupt families who still cannot receive Medicaid in UT because of UT horrible state statutes and "cost saving". For a state that is supposed to be so "Christian", it sure does not take care of the sickest very well!!!!

  • Dave
    Aug. 19, 2009 8:16 a.m.

    I get medicare taxes taken from my check. AND I pay high premiums for insurance for my family, through my work, that could be considered a "catastrophic" plan. I pay out of pocket for almost %100 percent of my health care. I love my parents - even more than they hate Obamah - but even though my Dad worked hard his whole life, there is no WAY he "saved" enough in his medicare "account" to pay for all the medical expenses he and my mom will need after they retire in a year. They like to THINK that medicare isn't a big bad government run, socialized medical care program. But, the truth is, medicare will pay for all their medical costs - minus a small premium - regardless the amount they've payed in. It's government run health care. I'm not saying I'm for a nationalized plan, I agree that we shouldn't have to choose between "socialism" or the status quo. There has to be something that allows for market forces to control costs AND keeps medical expenses from bankrupting families and our Government! But I do hate people using Medicare/medicaide complaining people who also want national healthcare

  • Dave
    Aug. 19, 2009 7:11 a.m.

    Medicaid is a practicaly free program for the poor. Medicare is a Gov ins. program for those over 65. Seniors have been paying into it most of their lives and continue to pay premiums for the coverage ( it is a good deal).

  • Compare
    Aug. 19, 2009 6:37 a.m.

    Let's see a 1.5% savings by tightening up controls on Utah Medicaid or 20% profit and overhead for insurance companies. With all of the insurance money going to politicians, this $20 million is a pittance. It would not even pay one of the top insurance company's CEOs for one year's compensation. If given the choice between a government system that is closely audited, controlled and publicly transparent or insurance companies that pay their leaders in the millions, I am ready to consider a change.

  • Silva
    Aug. 19, 2009 3:59 a.m.

    This is Utah's problem, not medicaid. Other states have tight controls and use software that is not 20 years old.

    This is the price we pay for having one party rule for to long.

  • Medicar & Medicaid
    Aug. 19, 2009 3:40 a.m.

    These two health care programs were created to be a health care program for retirees, not general public welfare. Medicare, medicaid, and SS were doing just fine as a private individual program until congress decided they wanted the money to balance the national budget. It helped that but then when they got their hands on the private accounts lobbyist decided it was for general public welfare, not americans and retirees on SS.

    Medicare and Medicaid are nearing bankruptcy because of 20 million illegal aliens are stealing our private account funds for free health care.

    These three programs that every tax payer pays in to are private accounts for every individual that has paid in to it and have legal SSN's. The only way to save these programs for everyone's retirement is to re-establish them as private accounts that belong to those paying in to them and not for congress to steal. They are private savings accounts that are being stolen and abused by congress.

    The under thirty generation do not understand that these accounts are their personal property for retirement and it is being stolen from them and their parents, the real fraud being committed.

  • No wonder...
    Aug. 19, 2009 12:21 a.m.

    we can't win a war. The government runs the military, and it's FULL of fraud, waste, and corruption!

  • JMT
    Aug. 18, 2009 11:03 p.m.

    One correction, you don't say "yes we can!" You must chant it like some ritual, which was very unnerving to me when I heard it in Chicago. I know some found it reassuring. Many others like myself did not.

    In any case, if you think this fraud is bad pass Obama-care and watch it grow into tens of billions.

    The concept of fraud is that you aren't making enough money so you do something illegal to increase the amount of money in your pocket.

    Once the government decides how much doctors, clinics, and hospitals make the fraud will follow. Or they will simply move to other countries. Research the growing shortage of doctors and nurses in England and Canada. Many great doctors are moving to Mexico, and the Far East for the freedom to practice. It is a trickle now, pass Obama-care and it will become a torrent.

    Socialism does not thrive, at best survive.

  • Alternative
    Aug. 18, 2009 10:32 p.m.

    I purchased a catastrophic health insurance policy for my family that I am pleased with. Yes, it has high deductatbles and it only pays 85% but I am happy to have it. My monthly premiums fit my budget and I sleep at night. For the usual doctor visits, I pay out of my pocket. If we want health care, we are going to pay for it, either in very high taxes or the way I am. If we think the government will do a better job than you can, read the article and ask yourself if you really believe you can get "free" healthcare? Nothing is free, but this you can believe in; Government sponsored health care will not be cheap, especially when it is always full of waste, inefficencies and corruption. There is no such thing as "free health care".

  • doctor
    Aug. 18, 2009 10:15 p.m.

    as a practicing physician, it is nearly impossible to get many very necessary tests approved with medicaid; most of us don't want to deal with medicaid as all of the government redtape involved makes it so that the overhead costs more than it is worth.

    the fraud is likely not fraud but government waste.

    We indeed need reform, but I have not seen any type of reform proposed, just more of the same waste.

  • get real
    Aug. 18, 2009 9:50 p.m.

    To "only for the select few" and JT....of course nobody on medicaid is complaining...it's free!!! Jt would sign her whole family up because...it's free!!!! Entitlements will be the ruin of this country.

  • corruption?
    Aug. 18, 2009 8:56 p.m.

    Corruption - what do you think Medicare and Medicaid are??? They are national health coverage - for MILLIONS of Americans - granted not all Americans - but a very large number of our population use it and LOVE it. My Grandma depends on in, my parents have to wait until they are eligible for it before they can retire because they would have "pre-existing" conditions that would make private insurance too expensive. If you truly believe in LESS government you would be demanding a change in health care. Nothing has been done for years. More and more of our tax dollars are going to fund these programs - our government is getting BIGGER, not smaller. I'm not necessarily a Obama fan, but at least he's trying to do SOMETHING. The republicans would run this country into the ground before they would see Obama succeed. Rebulicans just rant about how much they hate Obama, and make up nonsense about "death panels" They had 8 years to make positive changes, and they did nothing. Palin should take her own advice and "stop making things up" and republicans should stop griping and start coming up with ideas...

  • Corruption?
    Aug. 18, 2009 8:26 p.m.

    If you think corruption in Medicare and Medicaid is bad, just wait until you get national health coverage! Part of the corruption is that these programs are exponentially more costly than we were told they would be, just like Obamacare will be! Don't buy this people, it is an invitation to waste, corruption and abuses!

  • dewey
    Aug. 18, 2009 8:05 p.m.

    It's nice to see both arguments on here, I would have thought it would have been totally one sided.

    I agree something has to change, to blame the government is not accurate, it's the bad physicians who have found a cash cow that to date has no repercussions for illegal activity.

    An overhaul of the whole structure of compensation for medical profsessionals is badly needed. Our current structure of increased income based on uneeded tests, prescriptions, and treatments just to drive up the bill. It's sad that we the public have put up with it for so long. Yes it get's brought up about every 10 years for the last 60 years but never goes anywhere. We should be furious that we're held hostage to the premiums we're charged to have insurance only to be denied claims, because we went to the wrong doctor. This should never be acceptable to a society, yet here we put up with it time and again.

    Here's something to consider: Do you think the insurance companies, or your government are more worried about your health care costs and services?


  • Ridgerunner
    Aug. 18, 2009 7:48 p.m.

    More proof that the government can not run healthcare! Even if Obama says, "yes we can".

  • Future!
    Aug. 18, 2009 7:09 p.m.

    Folks welcome to government sponsored health care! Corruption, waste and inefficiencies abound! Just say no!

  • only for the select few
    Aug. 18, 2009 5:56 p.m.

    I don't know anybody on medicaide that complains about it. I know several Glen Beck/Fox news fans that have children or grandchildren on medicaide. There is a ton of waste and corruption in medicaide! We need a VERY stringent program that only allows for procedures that are necessary. No more ER visits for ear infections. I know a family that do that ALL THE TIME - they don't have to pay for it - they don't care what it costs. I think we should also require mothers to name the father's of their babies before we enroll them in medicaide to make sure the Father's are paying the state for at least some of expenses. There are a lot of things that could be done to make medicaide work - and if EVERYONE was a part of it - you would have more people pressuring the politicians to make it work.

  • 4:36
    Aug. 18, 2009 5:45 p.m.

    As a 30 something, I'm glad to know that so many of you who are against government run health care will NOT be enrolling in Medicare when you turn 65! You will be true patriots and buy your own health insurance - good thing to plan on since the program is supposed to be bankrupt is several years anyway. I don't understand why it has to be one or the other - insurance companies with fat paychecks or government waste. I would like a blended approach. Similar to the section 8 housing program. Everyone has to buy insurance and pay for it with their own money and pay their own bills - up to a percentage of their income. If they get a S.S. check it comes out of that, if they get a paycheck it comes out of that. BUT, if their medical bills exceeds the percentage of their income that is determined fair - the government steps in and pays the remainder of the bill. So, a family making $50,000. a year don't have to sell their home or go bankrupt if Mommy gets cancer BUT if you make millions of dollars, you pay your share

  • JT
    Aug. 18, 2009 5:25 p.m.

    My disabled daughter is on Medicaid, and if I could put the rest of my kids on it, I would.

  • re:who is causing the waste
    Aug. 18, 2009 4:52 p.m.

    Certainly some is the doctors and insurance companies fraud but NO WAY is fraud the majority of the problem. Truthfully, as a career individual in the healthcare field, doctors and companies are buried in government regulation and yet it still happens. Most of the regulation is old, outdated, and ineffective. The govt just piles more on top. You can't hardly wade through all the regulation if you work with the govt.

    WASTE is the bigger problem though. It never ceases to amaze me how most private companies NEVER approach the levels of waste the govt does.

    It comes down to one primary difference.

    Companies care about the money because it is their own and it affects results/performance/earnings.

    Government does not care because they are spending someone elses money SO they always have lousy results/performance/lose money.

    Not too difficult to see why.

  • who is causing the waste?
    Aug. 18, 2009 4:35 p.m.

    Granted, the government needs to do better at monitoring this. But you know what's required...more regulation. It's the doctors and insurance companies committing the fraud on the system.

  • Anonymous
    Aug. 18, 2009 4:27 p.m.

    Here is the perfect example of why so many of us are against having the government interfering in health care. How obvious can it be that government can't manage ANYTHING without fraud, corruption, & waste???

  • Nation health plan??
    Aug. 18, 2009 4:00 p.m.

    And there are those that think that by magic this would not be the case in a nation health run plan. If there is a national plan it will have more fraud and waste more tax payers money than anything the govt. has ever provided. Also add another entitlement that many think they deserve.

  • Who?
    Aug. 18, 2009 3:41 p.m.

    Who will lose their job over this waste?

    Nobody because it is government. They always have an excuse as to why they could do nothing about the waste and inefficiency. They keep their jobs and we keep paying for their waste.

    A truly symbiotic relationship.

    Why we trust these legislators/govt entities to run anything is beyond me.

    We need term limits NOW. The first term would need to be about 24 hrs and it ought to be renewed daily by the representatives constituents.

    Do what we say or you are out.

    Instead lobbyists run everything in govt. That is why we end up with legislation that makes everyone go huh? It is not written for you it is written for the people who promise to fund the campaign for re election.

    Get ready for more of the same until the system changes.

    What a joke!!!

  • Fraud and Waste???
    Aug. 18, 2009 3:35 p.m.

    How can this be? This is run by the government right?

    Darn, and I had such high hopes for them running an efficient "govt option" for healthcare coverage!!

    NOT!!!!

    You have to be near idiot status to not acknowledge the government is consistently HORRIBLE at administering almost everything they do.

    The waste they get away with is almost incalculable yet you have mindless democrats lining up to give them more control under the deranged belief that somehow this time they will do it better.

    The definition of stupid:

    Doing the same thing over and over and expecting a different result.

    Its the Democrat motto.