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The Public Policy

The Fraud in Our Entitlement System

By on 2.2.12 @ 6:07AM

It’s just begging to be exposed, as an important first step in cutting our unsustainable national debt.

Though some might still deny it, there is growing bipartisan belief that our nation’s level of indebtedness is unsustainable. How we reduce the debt burden is another matter; this is where political knives are sharpened.

Yet there is one uncontroversial issue that could result in dramatic savings and, interestingly is almost never mentioned: fraud, fraud in Social Security, Medicare, and Medicaid.

The Social Security Administration (SSA) manages cash benefits for people with disabilities accounting for approximately $150 billion. There are two programs in this category, Disability Insurance (DI) and Supplemental Security Income (SSI), the former for workers with disabilities including family members and the latter for individuals with disabilities who have limited income and resources.

Remarkably the GAO analysis of SSA and federal salary data found that 1,500 federal civilian employees are receiving funds improperly to the tune of $1.7million monthly or $20.4 million annually. This is approximately two percent of SSA fraud cases which demonstrates the magnitude of the problem. In fact, there are literally hundreds of SSI recipients who receive their checks in Mexico City, to cite one example, who haven’t resided in the United States in years and who never contributed a dime to the Social Security agency.

The most flagrant example of fraud in the Social Security system is identity theft. Invariably SS numbers are stolen and used to open credit cards. In a plurality of cases the numbers are stolen from minors with no credit history. A similar method is used with stolen telephone and utility bills.

In general, there are three ways to commit fraud in the Social Security system including identity theft: Issuing false statements; concealing the truth; mishandling payments. When you apply for disability, an application must be filled out based on a claim. If you claim you are disabled and unable to work, but still maintain a job, that is fraud.

No one at the GAO can give me an accurate estimate of fraud and the SSA admits it cannot monitor the fraud cases. Hence any estimate is likely to err on the conservative side. On SSI and DI alone, fraud probably accounts for at least 2 to 3 billion dollars. And this represents only two of the many Social Security programs, albeit the ones most likely to engender fraud cases.

Medicare fraud is rampant and as is the case with Social Security hardly ever prosecuted and generally undisclosed, despite estimates about abuse that appear in the Congressional Record. The fraud occurs when people or companies bill Medicare for services that were never provided or received or were unnecessary. Providers generally commit fraud when services are not given. A common practice is “gang visits” in which a provider visits a nursing home and bills for services to all or nearly all the residents. In this case services may not be performed or, more likely, the provider performs a service whether or not the resident needs it.

When my mother lived in a Florida retirement community, a well upholstered van would stop and the driver would call for her three times a week. I asked my mom why she went to the doctor’s office so frequently, assuming there was a health issue that had to be addressed. She said, “A nurse takes my blood pressure and asks me how I’m feeling. I don’t have much to do so this helps pass the time. After all, it’s free.” It may be free for her, but it is not free for tax payers. Moreover, whatever the expense for my mom has to be multiplied by 20 to account for the others in the van.

Another fraudulent act, which occurs routinely, is “upcoding a service,” i.e. bill for surgery when only a band-aid was placed over a cut. Similarly, unbundling services is a way to pad bills by suggesting three or four tests intended to be one service are billed as independent services.

Suppliers commit fraud when they bill for a qualitatively superior product, but offer the marginal variety or bill for equipment that has been returned.

Recruiters are a growing problem on the Medicare front. These people often go door to door offering money and gifts as incentives for “free” medical exams. Needless to say, Medicare is charged for this solicitation.

Because of the availability of government “soft” money, scams proliferate. There are advertisements for medical plans that have not been approved; there are misleading plans that have not been approved; there is misleading information that encourages fraudulent acts, e.g. when a company offers Part D prescription plans at no cost to beneficiaries, even though Part D plans require beneficiaries to pay premiums.

According to FBI records, there are about 2,500 pending fraud cases a year since 2003, most falling into the “upcoding” category in which a routine doctor’s office visit is billed as individual therapy. However, these cases represent the tip of the proverbial iceberg since upcoding is a common practice among health care providers. So too are kickbacks in which money is exchanged for the referral of patient services that will be paid by Medicare.

Medicaid has many of the same fraud issues as Medicare, with provider bills that were unnecessary or never performed. Under Medicaid, a healthcare provider is paid by the government for each service it performs. Billing the government for fictitious services can be highly lucrative, which explains in large part why each year another “nursing home scandal” appears on the front page of local newspapers.

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About the Author

Herbert London is president emeritus of the Hudson Institute and the author of America’s Secular Challenge: The Rise of a New National Religion (Encounter Books).

Letter to the Editor View all comments (81) |

c. j. acworth| 2.2.12 @ 6:49AM

Maybe we could move the useless beaurocrats at the EPA over to the enforcement division of SS. They might be able to earn their keep for a change.

Doctor Watchdog| 2.2.12 @ 7:38AM

It's amazing how much corruption there is among doctors.

henry| 2.2.12 @ 8:44AM

Luce and Rubenfield (2002) published a study which showed that 40% of the total Medicare bill was spent in the last two weeks of life. Futile and needless hi-tech investigations (repeated MRI scans, blood tests, x-rays) and the obligatory stay in ICU all add up, and are very profitable. And all on the house, of course.
This is a system steeped in profiteering, fuelled by guilt on the part of relatives, and of very dubious ethics. Aptly called “entitlements", the system is unsustainable. Incidentally, I’m a seventy year old doctor, and will NOT subject my family to this abuse.

Michael Stein| 2.2.12 @ 1:21PM

@henry - I agree that this is a problem, not only for Medicare but for private insurance as well. But you do realize, don't you, that if a Democrat were to call for Medicare reforms that would put an end to this sort of thing, the Republicans would immediately start shrieking about death panels?

Neither party has been honest in talking about health care, frankly.

Addressing the article itself: not all of the unnecessary imaging is fraud. Some of it is defensive in nature - making sure the doctor cannot be accused of malpractice just in case this patient has some one-in-a-million condition that could have been caught and treated in time, even though the other 999,999 images will show nothing. OTOH, it is quite true that studies show a significant correlation between doctors' imaging orders and their ownership of imaging equipment. Nonetheless, any attempt by Medicare to rein in this excess by imposing tighter standards of medical necessity is likely to be slammed by politicians more interested in gaining advantage by cynical demagoguery than what's really best for both the country and the patients. And again, I'm pointing the finger at both parties on this one.

Thom| 2.2.12 @ 3:20PM

Dr. Henry,
I have known people who “doctors” gave less than six months to live and went on to live over 30 years with a chronic illness……Taken at face value what you are saying is that the opinion of some medical professional with a magic ball can predict when that magic “last two weeks ” is going to happen has life and death power over others. My mother went into a Nursing Home in May of one year and died in Sept with the absolute certainly that 1 of at least 5 falling systems would kill her but no one with the God like power you seem to think some Doctors have could have or did predict when that final “two weeks” would occur. Her last $1500 one way ambulance ride was completely unnecessary but mandated by the “state” like so much of what drives medical cost today. Be very careful for what you wish because at your age it is certain you are an elevated risk to our entitlement system’s future and your last “two weeks” could be right around the corner and you have absolutely no say in the matter….

macwell| 2.3.12 @ 6:25AM

Lucky for you Doc., but what about the rest of us schmucks? The problem is manifold, the solution easy, get the government out of the healthcare business. If Dr.'s were allowed to charge what they wanted, the market would correct prices. This is the year 2012, not 1913, we can do anything, yet we're still allowing the few to dictate to the rest of us.
Give everyone on medicaid a swipe card, everytime they go to the Dr.'s or hospital for service, they swipe the card, the computer stores all the info, they get treated and go home. The transaction is complete. The only real reform for medicare is to end it and allow companies to run it. How fast do you think they'd turn a profit?

As important as it is to get government out of the way, it's even more important to reform the tort laws, without tort reform all else is pissin against the wind.

Timothy L. Pennell| 2.2.12 @ 8:48AM

Yeah. Let's keep an eye on the Doctors. Thank God we have the Trial Lawyers watching our backs, and keeping the Costs of Medicine down. This is why they're the #1 CONTRIBUTORS to the Democrat Party, just ahead of the Teachers Unions. Because, just like the Public School Teachers that we saw taking Phony Sick Days, and bringing their Students with them (WITHOUT Parental Permission) as they Rioted in Madison, Wisconsin for everyone else to pay for their Health Care and their Retirement? The Trial Lawyers are always just a Slip and a Fall away, from making sure the Costs of Health Care are Low.

It's amazing how much Stupidity there is among Commenters.

Dai Alanye | 2.2.12 @ 10:36AM

Perhaps Pennell is missing the point. It's amazing how much corruption there is among doctors, but not at all amazing that there's a huge level of corruption among trial lawyers.

Timothy L. Pennell| 2.2.12 @ 11:44AM

You do make a good point.

Gerald| 2.2.12 @ 10:51AM

The corruption in nursing homes is staggering. I know because I worked in one for seven months, and did it open my eyes to waste!

A nursing home treasures a patient in a vegetative state. They're much easier to tend to. All you do is change the diapers.

Vegetative patients make no demands. They require no staff to shuffle them to bathroom, dining room. They make no complaints.

The nursing homes will keep the vegetative patients breathing as long as possible for financial gain. Medicare or Medicade pays every dime.

Hoskins| 2.2.12 @ 11:55AM

Vegetative patients, Gerald, are indeed a drain on our health resources.

Money spent on vegetative patients is money not spent on preventive care, such as flu shots and mammograms. Each night in an ICU bed for such patients is a night that another patient with a genuine prognosis for recovery is denied such high-end care.

Every dollar exhausted on patients who will never wake up again is a dollar not devoted to finding a cure for cancer. While the visible victims may draw the headlines and attract indignant protests from so-called "pro-life" organizations, the invisible victims are people like you and me who will suffer from diseases that are never cured because funds are being poured down a healthcare sieve in order to maintain permanently-unconscious bodies on complex and costly forms of life support.

How many of you would want to live in a vegetative state fed by a feeding tube for years?

TrueBlue | 2.2.12 @ 2:36PM

That's where cold-hearted people like us go and tell those families if they want the person to stay in hospital/hospice care in a vegetative state they can foot the entire bill.

I understand not wanting to see a loved one die, and in some cases these people even wake up, but forcing the rest of the country to pay for it (and it IS force through taxation with threat of jail time) is just wrong. If a family can't afford it they can ask for private donations.

L L with a Living WiLL| 2.2.12 @ 4:21PM

Yes, True Blue. I agree.

There is also a need for all of us to put in our living wills that when doctors declare we are in a vegetative state to REMOVE THE FEEDING TUBE IMMEDIATELY.

It's crazy how some families, ignoring the loved one's quality of life, demand more and more horoic efforts to KEEP THEIR LOVED ONE DYING.

Yes, dying! They are not living the kind of life that is worth living; that's for sure.

Norine D.| 2.2.12 @ 4:23PM

I have told my family repeatedly that I do not want to be given a feeding tube.

I have also spelled it out in capital letters on my living will.
No one in their right mind would want to "live" in a vegetative state.

Fed Up with Healthcare Waste| 2.2.12 @ 4:33PM

It's when you have a family member in a nursing home that you visit several times a week that your eyes are really opened.

A patient three doors down from my father yells periodically all day long "Help me. Help me!" It just tears your heart out. To put it bluntly, the man--a stroke victim-- would be better off dead.

My father, thank God, has a living will that states that when his body begins to shut down, he wants to die. If he gets pneumonia or any infection, he has asked me and his doctor to NOT give antibiotics.

My father is 84, in bad health, and is worn out. He is ready to go.

This situation has got to be addressed. Many of the patients on his wing look to me like they are in vegetative states or close to it.

In case you don't know, nursing homes are nightmares! If you get old and drop dead from a heart attack in your kitchen, you will be the lucky one. No nursing home horror for you.

Riff Raff| 2.2.12 @ 6:48PM

"Purp" has been living in a persistent vegetative state for years. As far as I know he still has a feeding tube.

MXLord327| 2.3.12 @ 4:27PM

Can't we get a court order to remove it??

Lyneuss Fields | 2.2.12 @ 12:57PM

Sure enough, isn't it simply amazing how Wall Street lost over 8000 points, and tens of millions of home mortgages, along with debt affixed to them, ended up under water? Oh yes, the credit market along with an equal number of jobs also went south—pun intended. Now let's blame the doctors, lawyers and retirees and don't forget to cut welfare to the poor—how sweet, simple and just a plan—Mitt Romney's our man!
http://lyneussfields.blogspot......their.html

L. Ross| 2.2.12 @ 7:44AM

I say, "Put the TSA in charge of monitoring benefits." This would be a place where their highly trained employees could be doing some good.

Timothy L. Pennell| 2.2.12 @ 9:49AM

Fannie and Freddie are still being Bailed Out. Fannie and Freddie are still making the same kinds of loans that got us where we are, today. One of the guys, accused by the GAO of "Cooking the Books" at Fannie and Freddie, "in order to reach their BONUS GOALS" is the present Attorney General of this Black President's: Blacks Only / Enforce the laws WE FEEL LIKE ENFORCING / Gun Running / Justice Department - Eric Holder, who, along with Franklin Raines and Jamie Garelick, made Tens of MILLIONS of Dollars in Bonuses.

We have a President who has CUT a TRILLION DOLLARS from Medicare. $500 Billion, to pay for his Soviet Health Care System, and $500 Billion more, to pay for his Re-election, from his Bogus Debt Commission. (That's what it was. None of that will go to the DEBT. It will go from One of his hands, to the other, as he gives away the store, to get himself FOUR MORE.)

But, wait. There's more.

After he's done all these things, he goes on T.V. to warn Grandma the "Republicans want to CUT Medicare.

I believe that the Medical Term is: SOCIOPATH.

This could all be solved, simply. Years ago, our young Pharaoh proclaimed that: "We can't get anything done on Entitlements, if every time someone comes up with a Bold Plan to make the kinds of changes that are needed to FIX the Entitlement problems, they get torn apart in a fit of PARTISAN POLITICS".

Can you say: PAUL RYAN?

Ryan has a good plan. His problem is, he has a Lying POS, for a President. A Narcissistic, Egocentric, Sociopath, with a God Complex, who has no problem Lying through his teeth, and dragging anyone who disagrees with him, through the Mud, if it will buy him ONE MORE DAY, on Air Force One. His other problem is that he has a Democrat Party, who's last attempt at "Reforming Social Security" was to have a picture taken of all of the Party's Leadership, smiling, as they gathered around a STATUE of F.D.R.
That was their Plan.

This can all be done. We had the Manhattan Project, that started with NADA, and came up with the Atomic Bomb, in the Blink of an eye.

We put a Man on the moon, and returned him, safely, just 9 Years, after JFK pronounced his Vision for NASA.

The same can be done with Entitlements. No Lawmakers. No Lobbyists. No Special Interests. We get Economists (Not the IDIOTS like Krugman and Reich, who never saw a Deficit or a National Debt, that was too high, unless a Republican was President)) REAL Economists, together with REAL Doctors, and REAL Insurance Professionals, and we hammer this out.

We have a President who likes to TAKE CREDIT for his Commissions, and his Fact Finders. His Advisers, and his INPUT Guys. The only problem is, he has no intention of doing ANYTHING they might suggest. They're nothing more than Window Dressing, for the Show Trial that he conducts, every time he opens his mouth.

Like his total pullout from Iraq, AGAINST the advice of his Commanders on the ground, and the Carnage that erupted almost immediately after. We are experiencing the Economic Carnage, brought about, by President Ideologue's UTTER CONTEMPT, for anyone who would Dare to presume that THEY know more than HIM. He never meets with his Cabinet. He never meets with Congressional Leaders. GOD does not speak to mere mortals. GOD sends emissaries. HIS ways are not our ways.

Nothing will ever be done, as long as the Democrat Party has any Power, in Washington. As long as Hussein is there. As long as Cowboy Poetry exists.

The Biggest Fraud in our Entitlement System is the Fraud in the Oval office. The idea that this guy, with his Life History. The idea that this Radical Leftist / Marxist / Communist / Anarchist / Muslim, is the President of this Country, and is SINGLEHANDIDLY bringing it down from within, in the span of 4 Years, is something that future historians will look at, and ask themselves, and each other: HOW could this have happened? How was it possible, that nobody saw this coming?

You might wanna consider that, as you ponder sitting this one out, come November.

Diogenes| 2.2.12 @ 12:10PM

Tim: YOU are a DEvout liar.

Diogenes| 2.2.12 @ 12:10PM

Tim: YOU are a DEvout liar.

Diogenes| 2.2.12 @ 12:10PM

Tim: YOU are a DEvout liar.

Diogenes| 2.2.12 @ 12:14PM

Tim: YOU are a DEvout liar.

Diogenes| 2.2.12 @ 12:14PM

Tim: YOU are a DEvout liar.

Diogenes| 2.2.12 @ 12:14PM

Tim: YOU are a DEvout liar.

DRed| 2.2.12 @ 12:31PM

Fannie and Freddie don't make loans. Eric Holder never worked for Freddie Mac or Fannie Mae. Seriously, Timmy. That's just your first paragraph, and everything you said is wrong. Nice work.

Timothy L. Pennell| 2.2.12 @ 4:03PM

You, Sir, are either STUPID, or a Liar.

I'm bettin it's both.

He worked at Fannie and Freddie. Fannie and Freddie GUARANTEE LOANS.

Why do you even bother, when you don't know anything? That's what Dumb*sses do.

Oh. Never mind.

DRed| 2.2.12 @ 4:51PM

Do you know the difference between making a loan and guaranteeing a loan?

When did Eric Holder work at Fannie and Freddie?

xiphos| 2.4.12 @ 5:54PM

Holder worked for Covington & Burling, a D.C. law firm with ties to Fannie & Freddie, according to a source (Reuters).

VonMisesJr| 2.2.12 @ 7:51AM

Milton Friedman said there are four ways to spend money. I can spend my own money, in which case I care about the quality and price. I can buy a gift, in which case I am not as concerned with quality, but very concerned with the price. I can spend someone else's money on me, in which case I have a nice lunch. Or I can spend other people's money on somebody else, and you have government.

The problem is not just the fraud. It is the seniors that go to the doctor for every minor issue, or simply to whine and complain. What do they care if someone else has to pay hundreds of dollars for them to complain to their doctor?

Darin| 2.2.12 @ 8:19AM

The majority of seniors likely believe they are "entitled" to this because they paid into the system. Problem is, they receive back what they paid in (with interest) within 10-15 years of retirement. After that, they are in effect taking money out of someone's pocket.

Al Adab| 2.2.12 @ 10:24AM

Just think Darin if those SS "contributions" were owned by the taxpayer, placed into personal IRAs or 401s or some such. People could pay their medical expenses, could pay off mortgages, could use their money as they see fit and every one of them would by age 65 likely be a millionaire. Yet the Left tells us there is something wrong with that scenario since people need to rely on government, not on themselves.

Dai Alanye | 2.2.12 @ 10:39AM

Medical Savings Accounts. Yes!

DRed| 2.2.12 @ 12:33PM

Milton Friedman must have been a terrible gift giver.

Al Adab| 2.2.12 @ 2:47PM

D A:
MSA absolutely. One of Forbes best ideas and BTW, why is he not in line to become Sec of Treas?

VonMisesJr| 2.2.12 @ 3:12PM

Hey Al. There is a county in Texas that did opt out and had their own retirement plan. It pays out about 5-6 times the return on SS.
But the whole SS thing was always a scam. The Supreme Court has ruled that you have no claim to SS returns. If the congress changes the rules or just defaults, you are SOL. This confirms that is a tax, always was a tax and will always be a tax. Sooner people figure that out, the better off they will be since it is going bankrupt by 2036, that probably means in about a decade once they tell us the real story.

Al Adab| 2.2.12 @ 3:55PM

Jr.
Exactly so. There is no acount with anyones name on it. Current taxes pay current benefits so ask Mr. Ponzi (or Madoff) how that works. I would prefer my own fund. BTW, which county is that and how are the real estate prices?

joe1cr| 2.7.12 @ 4:47AM

The only money that was took out of someone's pocket were those working Americans paying into social security fund.
It was stolen from them by LBJ and the liberal democrats in 1964. If left alone the SS fund would still be solvent today.
Johnson consolidated the federal government's operating budget and the Social Security budget.
As he himself put it, "Mah frens, we've got one pot of money oveh heah...and we're spendin' more than we're takin' in. Thass what we call it a daffacit.
"But oveh heah, we've got anothuh pot of money...and there's more goin' in than is goin' out. Thass what we call a surplus.
"And if we just put the two of 'em togethah, thar'd be as much comin' in as was goin' out. Thass what we call a balanced budget."
Thus was the vault opened up to Congressional raids and Social Security doomed the fund money .
This is the legacy of LBJ's Great Society..compassion as defined by Liberalism and the following years have seen more programs added to the welfare system.
Now we have millions of illegal immigrants' on welfare, not to mention the housing bust of Barney Frank and Chris Dodd's
The liberals have killed the goose that laid the golden eggs they beat her to death with the sledgehammer of welfare all for there constituents.

tsd| 2.2.12 @ 8:05AM

The system is run by the GOVERNMENT.... enough said!

JayDick| 2.2.12 @ 1:01PM

BULLS-EYE. It is impossible for any government program, any monopoly really, to be efficient or effective over a long period. Mostly, it's even impossible for them to be effective over the short term too. Less government, especially the central government, means a higher standard of living for everyone because there will be much less waste.

Ryan| 2.2.12 @ 8:46AM

One of the fascinating parts is that it appears that simple documentation and paperwork fixes could be put in place at little cost to prevent subsantial fraud.

JayDick| 2.2.12 @ 1:04PM

That is an illusion. If one form of waste is reduced, another will pop up quickly. The only solution is to get the central government out of as many activities as possible. Push necessary government services as close to the people as possible.

David W| 2.2.12 @ 9:08AM

The reality TV show called "Jail" showed a young man who was arrested for being under the influence in public. He was arrested not because of possession but because he was a danger to himself. He was released the next day.

As he is leaving one of the jailers asks, "how much pot do you smoke?" He said 12 blunts a day. The person asked, "how do you pay for all of that?" The answer? He 'borrows' money from his grandmother and SSI!!!!!!

The Bishop| 2.2.12 @ 9:25AM

As with tax evasion cases, the federal government only prosecutes for publicity value. If they believe that the public pays attention to a prosecution it will have a multiplying effect on potential violators who, supposedly, will think it's not worth the risk. Only 2,000 - 3,000 criminal tax cases per year are pursued for fraud out of multiplied millions of potential violations. Defrauding the federal government is a low-risk gamble. Think of how many law-writers have violated their own legislation. And it's the taxpayer who pays.

Ground Control| 2.2.12 @ 9:32AM

Gee, there is fraud in a nationally administered, ultra-insulated bureaucratic institution that is designed to hand out free money to people who did not earn it. Wow. What a surprise. Fraud is not the problem, it is a symptom of the problem. The problem is corruption in government that encourages corruption at the local level. The further insulated the bureaucracy is from the people it ostensibly helps, the easier it is for people to cheat the system, and this is intentional. The more money that is handed out, whether legitimately or by fraud, the more votes that are bought. This is the purpose of Federal Entitlement programs, to hand out money by any means necessary in order to buy votes.

This is why the US Constitution prohibits the US Government from funding or operating entitlement programs. LOCAL charity programs can more easily monitor the money being spent, and can more easily select who qualifies for help and can actually council people who receive monetary assistance to help them get back on their feet or improve their lives. LOCAL charities are designed to help people recover from problems, not lock them in to an endless cycle of dependency. Such things are most effectively handled at the local level, that is assuming the intention is to HELP people. It is self evident that Federal Entitlement programs are NOT intended to help people but to buy votes with other people's money.

Thomas Jefferson was right saying that most government functions should occur at the local level and the US Government should be limited to a few defined and authorized functions. This is what the US Constitution does, it defines and thus limits what powers the US Government has by LAW, and the power to hand out Federal Entitlements is NOT such a power, and the US Government has absolutely ZERO legal authority to run entitlement programs. If you want to stop the corruption and fraud, the only way is to eliminate Federal Entitlement programs altogether and turn these functions to State and Local governments.

Maddox| 2.2.12 @ 11:03AM

Therein lies the problem, the solution, and the fact that our country is doomed. Government is consuming prosperity and morality and will not be stopped. The possible replacements for the current crooks in charge are, at best, lighter crooks. It was a good ride while it lasted.

Thom| 2.2.12 @ 6:29PM

That would mean those that we send to Washington DC would have nothing meaningful to do most of the year......

P.Smith| 2.2.12 @ 9:32AM

Every single person that I know that receives Supplemental Security Income or Disability Insurance doesn’t deserve it, and as far as I can tell, not one them is truly disabled. One of the interesting things is those few people that I know who are disabled and might actually qualify for these benefits (and maybe they do receive them, but I’m not privy to that information) actually have jobs.

Maddox| 2.2.12 @ 11:04AM

Ditto.

Janwly| 2.2.12 @ 6:29PM

I, however, know a great many people who are truly disabled and have a great deal of trouble proving their disability to SSA (meanwhile, some become homeless, go without medical care, go hungry, etc.). SSA assumes every applicant is guilty of malingering and fraud until the applicant can prove otherwise. I thought we were supposed to assume folks were innocent until proven guilty (nevermind reasonable suspicion of guilt, due process, and the like).

Furthermore, the protocol for proving disability is set up for someone who has a sudden catastrophic injury, and who can always do x (for example, carry 10 pounds, walk, or move their left hand) but never y (for example, carry 50 pounds, see, or move their right arm). It doesn't work very well for people who have a chronic illness who can sometimes do x (for example, walk, read, or concentrate) for a short time (long enough to make it through, say, a 10-minute examination or perhaps even an hour or so), but not long enough to continue doing that all day (much less 5 days a week, weeks on end).

If this is difficult to understand, suppose you had a very bad case of the flu constantly, plus you had a chronic migraine, and you could never sleep well at night. On top of that, your brain has a tendency to blank out, forget things (some days you do not know what a spoon is called!), substitute random words (you meant "spreadsheet" but you said "station wagon"; you have no clue why), and otherwise work very slowly; thinking is like working through thick molasses. How long could you work under conditions like these? Do you think your boss would be happy with your work?

However, these problems are most likely to happen when you are most tired. It's unlikely they will be listed in your medical record. You can't work, but your doctor doesn't follow you around all day. You see the doc for only a few minutes, and the doctor is in a hurry and mainly wants to know if your kidneys are ok or if your heart rate medicine should be changed. So there is not much in your chart to support your disability claim.

I'm all for catching fraudsters (though the majority of the fraud is industrial, not from applicants, from what data I've seen) and for local control of programs.

I just wanted to point out that the system isn't working for the chronically ill.

Thom| 2.2.12 @ 6:30PM

I can't remember the last time I saw a disabled person get out of vehicle in a handicap parking place.....

"if you build it, they will come......."

nathan| 2.2.12 @ 9:43AM

Ground Control is dead on the money. Madison, in opposing a bill for giving money to refugees from the French revolution made it clear that he could find the article of the Constitution that allowed him to spend his constituents' money on behalf of benevolence. If he, the Father of the Constitution couldn't find the article, it doesn't exist.

And good intentions are never an excuse, NEVER for bad behavior at any level. By their actions ye shall know them. The fact that Medicaire, Social Security, Medicaid, food stamps, all of these were concieved with the noblest of intentions is so totally irrelevant. They were and remain unconstitutional and while the requirement to assist those in need is there, other, legal, constitutional ways must be found to accomplish those goals. That principle applies to national security too folks.

Mike 3/505| 2.2.12 @ 9:43AM

I am not condoning how some doctors abuse the system, but if the government continues to fix prices, then doctors are left with no choice but to make up revenue on volume. It's that economics thing. Get the government out of medicine and watch prices drop and quality go up.

Dai Alanye | 2.2.12 @ 10:43AM

Right or wrong, ethical or unethical, not only doctors but all of us will tend to fiangle or resist when someone attempts to restrict our income. It's human nature, and the only practical control is to get the government out and allow the market to work.

Therefore, medical savings accounts.

Marshall Akins| 2.2.12 @ 10:18AM

Watch the "Wild and Wonderful Whites of West Virgina" (http://wildandwonderfulwhites.com/). It's a shame those people get a dime of government assistance.

A Pismo Klamm| 2.2.12 @ 11:28AM

Don't forget the massive fraud in the VA 's disability system. As a retired clinician, I watched as hundreds faked disabilities to get Uncle's check for life, even going so far as joining the military with an agenda to end up on disability... If Uncle would pay a private fraud investigator .01% of recovered funds over time, that contractor would
be fabulously wealthy ... Bear in mind that I'm only addressing FRAUDULENT disability claims... Honest and responsible vets deserve the best of care and support. Semper Fi

JudyNM| 2.2.12 @ 1:07PM

I know of a 40 year old man who is on SSI due to bi-polar (aren't there thousands of working American who have this condition?) who works jobs 'under the table' per his mother. They should find a couple of these people and put them in prison as an example - encourage people to turn them in. It's thievery, plain and simple.
I also know of a 17 year old who is receiving social security because she lost her father at 15. She is claiming 'home schooling' yet she has not been near a book or done any studying. Does the SSA check on this? NEVER This is both fraud and child abuse. What chance does this young lady have to succeed with no education.
We have become a moocher society, aided and abetted by friends and family who look the other way.

Ron| 2.2.12 @ 1:25PM

Mr. London,

Thank you for the reminder about fraud...But I am 46, and ever since I can remember, every Congress since I cared has promised to clean up fraud and waste in various departments...The DOD (remember their $500 toilet seats, and $300 hammers), Medicare and SS was promised, I think in the 1980s, 19902, 2000, and now again.

It never happens...those "medical providers" with a vested interest are never going to change, because lowering the reimbursement rates will simply cause them to double their efforts. And the only other possibility is to enlarge the bureaucratic organization to add investigators and auditors...There is no savings there either, just another enlargement of the already bloated government.

Reform is needed, and I mean slashing.

Thom| 2.2.12 @ 6:14PM

Ron,
Have you ever tried to supply the “government” with something it says it wants? It takes an army of lawyers to understand the details of a government contract and time is money to every business. Those toilet seats and hammers might have been something you and I can buy at Wal-Mart for $10.00 but so can any government bureaucrat for the same amount. When the government puts something in a contract like that it is usually “special” in some kind of government way (be it necessary or not) but the cost of dealing with “government” carries with it an enormous overhead and overhead is routinely spread over the entire contract. Those $1000.00 wrenches for the Titan IIs were just as outrageous until you looked at what they really were and what it cost to setup a production line and build just 54 of the things. You couldn’t buy them anywhere in the world off the shelf. None of this is meant to mean there isn’t waste and fraud but try dealing with the “government” and see just how wasteful it is of your time and then see if you still think this is a one sided deal.

snipelee| 2.2.12 @ 2:13PM

A large component of the fraud problem lays with today's PC attitudes. Nobody can or will "call someone out" regarding fraud. If the government really had an interest in combatting fraud, a simple 800 number would suffice. The reality is that SSI, Medicare, and Medicaid are easy ways to redistribute wealth. NO one really cares!

rhcrest| 2.2.12 @ 2:26PM

If it was up to me i would end all entitlements. There is no constitutional authority to take money by force from one group of people and give it to another. Poor people and the truly disabled should rely on church, charity , family and friends for help when they need it. It is theft plain and simple to take money by force from one person to give to another. Whether the person you are giving it to really needs it is besides the point. The reason you are stealing it does not jusify the fact that you are stealing it. People would feel shame if they had to go face someone other than the gov;t to ask for help and that is how they should feel for getting something for nothing. The feeling of shame is what will motivate them to get themselves out of the situation. THe way it is now they get money from a faceless organization without any realization that the money they are getting came from the sweat of someone else's brow.

Thom| 2.2.12 @ 3:07PM

As long as the benefactor and the payer are separate entities you will never get rid of the bulk of the Fraud/abuse because you will never have enough bureaucrats to run down all that is required. Like a Toll road, the cost of collecting tolls over the life of whatever you are paying for becomes a significant part of the total cost of the "whatever". 78 million baby boomers minding their "own" money will be self-regulating before the fact compared to anything the overpaid bureaucrats in Washington DC could ever hope to accomplish after the fact. As long as there
is no self-interests on the part of the one getting the "free" stuff to manage someone else's money wisely this problem will live on ..... Everything the government subsidizes or makes "free" is ripe with Fraud for this very reason.

cicero| 2.2.12 @ 4:53PM

Let's not mix the problems together. The trial lawyers always come into the argument whenever the doctors are accused of abusing the system. There were at least 3 government investigations between 1979 and 1995, looking into the problem of nuisancet lawsuits. All three studies concluded that there was no such problem. Nowithstnding, Michigan adopted the holy grail of all reformers - medical malpractice tort reform. Now they would show the world how it would be so much better. The docs would not have to practice medicine in fear, and they would not have tp pay such outrageeous insurance premiums, allowing them to lower their charges. Needless to say, nothing like that happened. Their insurance rates are still the 2d highest in the country. The incident of malpractice continued unabated, with only the injured patients being hurt.
The rea lproblem is the intrusion of the government into the provision of and payment for medical services. Cicero's first law of economiccs states that "Debt expands to meet the money allotted to it.". The more money govenment throws at medicine, the more expensive it gets. When it is free, it gets over used. The solution will come when the government tells the doctors what they can charge, where they can practice, whom they must treat, and what type of treatment they can render. Oh, that is already here - Obamacare.
The solution may very well lay in the hands of the medical profession itself. However, that will require that they give up the guaranteed pay, and accept what the patient can afford to pay out of their on pockets. There will be a period of adjustment. Good luck. Otherwise, just keep moving in lockstep through the shoot.

albert constantine jr.| 2.2.12 @ 9:09PM

"Otherwise, just keep moving in lockstep through the shoot."

I hate to presume, but would you mean "chute" as in the slide to the slaughterhouse, or "shoot", as in event staged for either gunfire or filming?

Mike Daly | 2.2.12 @ 6:54PM

Entitlement programs by definition are pyramid schemes - it's why they're so laded with fraud.

POST American| 2.2.12 @ 10:17PM

--------------------FINAL WORD------------------------

---AS we brace for QE3 and another round of
'Banker Bailouts'

--------------------------------WHO'S ENTITLED?

"Understand folks, Globalism, 'Free Trade',
USURY, TREASON and EUGENICS are
ALWAYS intertwined. ALWAYS."

Psychopathic, fractional reserve USURY
-------------------------IS------------------------
-------------DEVIANT ECONOMY----------.

The LAW of Moses
---------WORD of GOD
-------------TRUTH of CHRIST. . .

-----------------------ALWAYS--------------------------

Agreed| 2.2.12 @ 10:21PM

I so agree with you on this, and you have just hit the tip of the iceburg. Did you know that parents can get their children diagnosed with ADHD and then claim disability to get SI payments for the child? I think everyone who collects a check should have to do SOMETHING....lick stamps, stuff mailers, telemarket...something...in return for the check... included in the process should be a checklist of capabilities that the person can do and those strengths used to work for the government in return for payment. Can they speak ? ...Let them answer phones or make phaone calls. Can the move their hands ?...they can stuff enevelopes.... etc..etc... That would create jobs and cut welfare fraud.....Also, a fraud hotline with investagators and rewards would help but that's too logical.

Augusta| 2.3.12 @ 12:12AM

Frighteningly, Romney isn't aware that anything in the system needs fixing. 'If it's broke, he'll fix it' he says. I find it disturbing that he doesn't know - yet he wants to be president.

Linda Joy Adams| 2.3.12 @ 1:16AM

Senator Coburn has the documentation of the trillions stolen by the govt contractors. Yet, no laws have been passed to reinstate what always used to be: internal audits of govt contractors to make sure the Constitution and laws are upheld and no thefts on the illegal offline computer system that should have been shut down a decade ago and is still being used to create multiple payments for their owners out of each claim and the monies are not going to medical sources. Also: the immunity from prosecutions needs to end. You steal; you alter diagnosis codes to circumvent asking the primary payers to pay you go to jail for attempted murder or murder when busy ER doctors rely on the fraudulent national health data base that does NOT reflect what ones doctor sent in. One congressional study on wrongful death malpractice suits indicates upwards of a million have died after Sec Of HHS Donna Shalala suspended enforcement of conditional payment laws in 1994 and caused the collapse of our health care system as this is the underpinning law that made everyone' behave.' Linda Joy Adams with files and monies missing in 5 agencies under the control of Affiliated computer services and their ' affiliates.' such as SC Blues which now has almost a monopoly of the Medicare claims processing through their various subsidiaries and were allowed to buy Cigna that had not been engaging in the multiples: now they just got tied in to the illegal system owned by the investors of their companies - the investors of the Federal Reserve?

Marc Jeric| 2.3.12 @ 12:16PM

There was a case of a doctor in Washington DC who charged Medicaid for an average number of patients of 145/workday. In 8 hours or 8x60=480 minutes, that amounted to abour 3 minutes per patient. Talk about fraud! All his bill were paid on time.

shipley130| 2.3.12 @ 1:06PM

Well, American Spectator, how about investigating the story that Obama is using a stolen SSN....from Connecticut.

William Varney| 2.3.12 @ 2:47PM

I would not doubt it .Whiteys laws do not apply to them

William Varney| 2.3.12 @ 2:43PM

Cut out illegals. I worked 40 years and paid into it
the illegals get it for free/

Geoff| 2.3.12 @ 4:05PM

Gingrich has emphasized the issue. Just saying.

Snertly| 2.11.12 @ 3:26AM

Which is more egregious, fraud in entitlements or fraud in military spending?

CJohnson| 3.6.12 @ 12:57PM

Not sure if it's 'fraud' but 3 separate specialist MD's see my elder parent every month, tell her she is getting old, and bill the taxpayer for their diagnosis. Occasionally they conduct an expensive test to prove they are right.

forumsforjustice| 4.30.12 @ 11:27PM

fraud is the #1 problem in America

7 million illegal immigrants, using false, or stolen, SS numbers, are fraudulently working, in NON-AG jobs

IT'S GAME ON Americans, first things, first ... Issue #1 - Illegal Immigration http://bit.ly/GFxhUJ

forumsforjustice| 4.30.12 @ 11:33PM

7 million illegals, using false, or stolen, SS numbers, are fraudulently working in NON-AG jobs http://bit.ly/hnHEbs MANDATE E-VERIFY NOW

John| 6.26.12 @ 6:43AM

Capital One

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