WRKO>Audio & Video on Demand>>Thomas Burton, Wall Street Journal

Thomas Burton, Wall Street Journal

Nov 14, 2012|

Thomas Burton, Wall Street Journal

Transcript - will not be 100% accurate

The nursing homes are ripping off Medicare you don't believe me ask Tom Burton who works for the Wall Street Journal. He wrote a story about it in today's paper Tom Larry -- Doing fine thanks tepid -- -- How badly are nursing homes overbilling Medicare. For for skilled services and other services that they provide. Well is that that recent reports made public today by the office of the inspector general of Health and Human Services Department concluded. That. A billion and half dollars is the approximate amount by which nursing homes are overbilling of Medicare system per year. And how widespread is the problem like -- -- -- it was this a small sample. Or worry it was it you know just certain parts of the country that are are guilty of -- No it was it was around the country it was a relatively small sample but it was a random sound sample. And and a large enough sample. It is enabled the inspectors to calculate. The rate at which claims were being. Miscalculated and and that rate was -- around 25%. In other words. 14 of all claims submitted. By skilled nursing nursing facilities. Turned out to be inaccurate and of those the vast majority were inaccurate on the high side in other words they charge. Too much yeah -- under urged his. At 2% were under church I think the number was and about 23% were overcharged. And a 1000000005 is just the nursing homes this doesn't include the doctors in the visiting nurse associations. Or anything else that to bill Medicare for services this is just the nursing homes one point five billion dollars. That's correct and and it's not just the nursing homes all of nursing on its just the nursing homes that provided. Skilled therapy assistants speech therapy occupational therapy physical therapy and the like. Now with the impact on the taxpayer you know because what you talked to people about this in the kind of shrugged their whole shoulders I told June about it this morning my cohost. This is I -- and so what you know the it that this is a big deal. You know it is a big deal and and it's it's especially big deal now that the president and the House of Representatives or are fighting. To avoid this fiscal cliff and one of the biggest issues is Medicare expenditures and and it seems to me that this would be a political issue where it would be in everybody's interest if the Medicare system and an -- of a lot better job. In monitoring this phenomenon you know and in in probably single main reason these abuses take place. In the system that's called feed for service not a word. If they do one session physical therapy they've built for one session physical therapy. -- also in this case they -- even if they didn't do the physical therapy. Rather than. Being being paid per patient per time period. Now is there any any talk of -- you know giving Medicare the teeth they need to go after the abuse and me because. It it seems I give you spent -- you're wasting a billion fives are so give them the authority to audit some of the stuff. And the the resources they need to audit you -- of days seemingly safe credit and money. They could save a lot of money I think the main impediment -- is whether it's whether retirement nursing facilities. Were doctors and hospitals. Where and when they get squeezed financially they tend to complain that local congressmen and when congressman. Here -- complaints like if they tend to put pressure medic here to do less resident more scrutiny. -- -- Because -- we have inning to look forward to in terms of solve this new. Well I don't know I'm I'm an optimist by nature so I think maybe you waved it. It is kind of ironic. The Office of Inspector General confined to this amount of what looks to be fraud. And very little has been done by the so far. I wonder how much fraud there is with Medicare when you look at all their programs on an aggregated basis if you ever study that -- I personally have not studied but I know that for example the institute of Madison has which is. You know very credible organization and and another Fella is some. At Dartmouth professors who runs the Dartmouth atlas and they've kind of independently concluded. That 30% is the approximate amount by which. Medicare gets defrauded across the board. You know it in nature really. Skeptical. About the need to raise health care premiums did you hear this right you know and current world getting. You know the senior citizens are gonna find out that their Medicare part B premiums are going up that they should be mad as hell right AD either either Medigap policies -- all of our health care costs I think are rising it. Six and a half percent per year on average since 95. -- -- when you look at -- in you say well yeah but how much of that six and a half percent increase each year is related to fraud it's a big chunk. And yet your absolutely right and you know there has to be a solution other than simply cutting benefits. Right right EE eight -- is instituting some just basic internal audit procedures with seem to make some sense right well. Go ahead tops -- No I'm supposed to. I agree entirely that makes total sense. Now all right well thank you very much -- time great job I hope you'll continue. They continue with this story is and others follow stood. Thank you so much that's Tom Burton Wall Street Journal that. Q off it is thirty quick I just went away would it that's what's even more -- right it's it's at these health care providers. It's. Nursing homes I mean I remember ahead and not who was in a nursing home. And I got to look at the itemized bill like a box of Kleenex forty bucks. An aspirin. Straw was 28 dollar I mean just like free easy crazy fees on this and you know people don't care physician while we -- what do I care it's it's -- you know they're billing the. They the government during the year ended their billing Medicare they beat the fact of the matter is. You could cut Medicare spending -- if you cut. Medicare costs by 30%. Just by having. Basic internal audit procedures in place Medicare fraud across this country is rampant whereas the watchdog. There is not one group on this date there is no watchdog that would be some jobs still young -- jobs they hang out -- just make it just very. Frustrating. When you. Hear that because you realize that that's that's a burden that's a cost when your mom's pain it right now and you and higher paying it because. Out of our paycheck every week. There's a line item in its called Medicare federal bureau is that it's all lumped into that the thing he called fight. But that money is going to Medicare and then 30% of that money is been given it given away in in the former fraudulent claims right. I -- -- -- had to do something about this on the set and that's what he can do about it and I wish I had read that article. -- will be back we'll take -- text messages 68680. Is my text number in my email address is Barry Armstrong at wrko.com.