●   Bản rời    

Nhân đọc bài viết "Medicare s $30M ambulance-ride mystery": Doanh nghiệp Mỹ gian lận và chủ trương của đ

From: Mike Wilson [mailto:wilsonaca@hotmail.com]
Sent: Wednesday, September 30, 2015 6:19 AM
Subject: USA : doanh nghiệp Mỹ gian lận và chủ trương của đảng Cộng Hòa

1. mỗi năm doanh nghiệp y tế Mỹ ăn gian nhà nước hàng chục tỉ USD qua chương trình Medicare bảo hiểm y tế.

2. các công ty xe cấp cứu y tế (ambulance)
cũng ăn gian Medicare nhà nước khoảng 30 triệu USD.

3. họ không có ghi sổ : bệnh nhân được chở từ đâu đến đâu, và được dịch vụ y tế nào .

4. trong khi quãng đường cấp cứu bình quân là 10 dặm, từ nhà bệnh nhân đến bệnh viện, thì các công ty ăn gian ghi quãng đường bình quân là 100 dặm !

5. một nửa trong tổng số ăn gian Medicare
là do các công ty ở  Philadelphia, Los Angeles, New York và Houston.

6. trên toàn quốc, có ít nhất 1 trong 5 công ty chuyên chở cấp cứu
dính nghi vấn gian lận .

7. ấy vậy mà đảng Cộng Hòa vẫn đánh phá chính sách giám sát tiết chế của nhà nước.

8. họ vẫn tiếp tục hát chiêu bài mị dân  của Ronald Reagan :&”vấn nạn không phải là doanh nghiệp, mà nhà nước mới là vấn nạn !&” - &”the problem is not business, the government is the problem !&”

9. ý hệ của đảng Cộng Hòa là chủ trương đánh phá mọi chính sách xã hội, bắt nhà nước đứng bên lề, không giám sát, không tiết chế, tạo điều kiện &”tự do&” cho doanh nghiệp thao túng thị trường và bóc lột cả nhân dân lẫn nhà nước !!!

10. hệ quả của tư duy này là: nếu nước Mỹ không có &”tự do chia rẽ bóc lột &”, thì nước Mỹ đâu phải là nước &”tự do&”... (!)


nth-fl

https://www.philly.com/philly/news/politics/

Medicares $30M ambulance-ride mystery

An ambulance sits at a hospital emergency center bay Monday, Sept. 28, 2015, in Houston. Medicare paid $30 million for ambulance rides for which patients got no other medical services either at the place they were picked up or at their destination. The mystery ambulance rides are part of a bigger problem with Medicare payments for transporting.

RICARDO ALONSO-ZALDIVAR, The Associated Press
Posted: Tuesday, September 29, 2015, 10:14 AM

WASHINGTON (AP) - Medicare paid $30 million for ambulance rides for which no record exists that patients got medical care at their destination, the place where they were picked up or anywhere else.
The mystery ambulance rides are part of a bigger problem with Medicare payments for transporting patients, according to a federal audit being released Tuesday.
The Department of Health and Human Services inspector generals office also found that some urban ambulance services got paid for an average distance of more than 100 miles per ride. That contrasts with a national average of just 10 miles for urban ambulance rides.
Four major metro areas seemed to be breeding grounds for ambulance schemes. Philadelphia, Los Angeles, New York and Houston accounted for about half of the questionable rides and payments. Medicare has barred new ambulance companies from joining the program in Houston and Philadelphia, and the report recommends a similar approach in certain other places.
Across the country, 1 in 5 ambulance companies had at least some questionable billings.
&”Medicare payments for ambulance transports have increased in recent years, and investigators have uncovered a variety of fraud schemes involving ambulance suppliers,&” the report said.
The audit involves medical claims dating to the first six months of 2012, but the inspector generals office said it believes the findings reflect continuing weaknesses in Medicares efforts against fraud. A Medicare spokesman says the agency has taken action since the auditors privately shared their findings last year.
Investigators went to great lengths to try to explain the $30 million in mystery ambulance rides.
The report said they did not count any cases in which the patient died within a day of being transported by ambulance. On the chance that some billers might have incorrectly reported pickup and drop-off locations, auditors checked if the patient might have gotten care related to their ambulance ride at another location. They scrutinized Medicares inpatient, outpatient, nursing home, hospice, and physician claims databases. To account for tardy bills, they kept watch for a whole year.
In the end, they were stumped. &”The transports may not have occurred,&” the report said. For 46 ambulance companies, there was no record that patients got medical services in more than 9 out of 10 of the rides they billed for.

Fraud costs the health care system tens of billions of dollars a year. Medicare is especially vulnerable because Congress requires the program to pay claims promptly in most cases. That has given rise to the frustrating condition that law enforcement officials call &”pay and chase.&”
The inspector general recommended that Medicare use its existing legal authority to require more documentation from ambulance companies and to give its billing contractors additional options to hold off paying claims that dont seem to meet basic requirements.
___
Online:
Inspector Generals report - https://oig.hhs.gov/oei/reports/oei-09-12-00351.pdf
Read more at https://www.philly.com/philly/news/

---