I can see no real reason other than politics. Much the same reason as defense appropriations are rarely cut back. In my 20+ years in healthcare, I have witnesses some truely astounding examples of fraud waste and abuse. Some examples:

1. A 25-bed Critical Access Hospital, located less than 50 miles away from 2 tertiary hospitals elects to enter the fields of spinal surgery and brain surgery. The result is services which were reimbursed under DRGs at the tertiary hospital are now reimbursed at a cost+ basis. A spine surgery which would normally cost ~$30,000 is now being billed for $150,000 - $200,000.

2. A 65+ patient presents to an ER complaining of a painful lesion on upper back causing stiff neck. Hospital then bills for a complete lab along with an MRI for what turned out to be an insect bite. Total bill was in excess of $6,000. Memo obtained from hospital directing physicians to maximize revenue due to short-comes in investment income.

3. A DME company who obtained a patient list from a large orthopedic practice sent Medicare recipients a "free trial" powered wheel chair and then billed Medicare for purchases even if the wheel chairs were returned. Company has history of fraud in 2 other states.

In only one of these cases to Medicare take action - which was to levy a fine and restrict licensure.

Federal authorities have repeatedly expressed that they do not have the resources to investigate a majority of these cases. State authorities are reluctant to take meaningful action as this would result in fewer dollars flowing into the local economy and, yes, the election coffers.

Medicare fraud, waste and abuse has been talked about for decades. While some significant headlines have been made by crackdowns, but the government's own estimates billions of dollars in waste remain. I have yet to see a tactile plan to address this issue that does NOT dramatically increase Medicare's administrative expenses - i.e., more auditors, investigators, care/case management staff and information systems.

There is likely hundreds of billions in fraud, waste and abuse, but I sincerely doubt the goverment will even be able to capture even a quarter of the estimates.

Thoughts? Rebuttal?

I question the logic behind the belief that making medical care a federal government issue will remove the profit motive out of it. Rather, the money will still be there prompting those motivated by profit to be attracted to it while making it politically motivated as well. Who really thinks those making millions of dollars a year off medical insurance will sit idly by while the federal government takes it over? There's no logical reasoning behind this, those making millions right now will find a way to continue making millions but this time with the blessing and backing of the US government.

1. A 25-bed Critical Access Hospital, located less than 50 miles away from 2 tertiary hospitals elects to enter the fields of spinal surgery and brain surgery. The result is services which were reimbursed under DRGs at the tertiary hospital are now reimbursed at a cost+ basis. A spine surgery which would normally cost ~$30,000 is now being billed for $150,000 - $200,000. Where did you get this anecdote?

Glad you asked SteveH. Here is the weblink to the hospital which describes that they are doing elective brain surgery.

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A simple Google search can find additional articles and press releases. As far as the costs are concerned, let's say it's my job to know. But you are free to contact this facility for an estimate. I can provide links to all of my anecdotes as well as many others if you are so inclined.

Thanks.