Health Care Crime

Of all the ills of American health care, least visible is the pervasive fraud it encourages in everyone involved--doctors, patients, labs, hospitals and, most of all, the insurers who manage the mess.

One small symptom can be seen today in a New York Times report of 91 Medicare audits showing “widespread violations of patients’ rights and consumer protection standards” in private drug plans for the elderly that were supposed to save them money but, in some cases, are endangering their lives.

Slap-on-the-wrist fines totaling $770,000 on 11 companies won’t make a dent in the billions they are raking in from the most vulnerable Americans, who might have been helped by authorizing Medicare to bargain with pharmaceutical companies or allowing medications to be imported from Canada instead of devising new ways for insurance companies to fleece them.

Other clues about the enormity of health care fraud emerged this summer when the new Justice Department Medicare Fraud Strike Force announced measures to crack down on medical companies that send phony bills or provide excessive treatments, pointing to 2,400 investigations last year and warning that more cases were on the way.

The FBI, which estimates health-care stealing to total between $60 and $100 billion dollars a year, lists a few of the ways it’s done:

Hospitals, doctors, pharmacists, and other care providers submit fake bills for services never rendered--or overcharge for those delivered.

Service providers bill insurance for unnecessary and costly procedures.

Doctors sell prescriptions to patients for cash.

Companies charge insurance for expensive equipment but provide poor substitutes.

Crooked M.D.s entice patients to visit their offices for "free services" or gifts, then steal their personal information and use it to file fake claims.

If you have a strong stomach, you can Google “health care fraud” and get 23 million hits, many reporting convictions of providers across the country. But reading too many may make you sick and in need of medical attention.

Middle-Class Health Care Crisis Gets Worse

The newest Census figures put a statistical face on the sickening truth about health care in America. Even as household incomes go up, so do the number of uninsured. The creeping crisis has moved beyond the poor into the middle class.

A record high 47 million Americans were priced out of health care, even as the poverty rate went down and median household income rose to $48,200 in 2006. Uninsured families earning more than $75,000 a year increased by 1.4 million.

As profits of HMOs, health insurers and drug companies soar, more and more employers are cutting down or eliminating coverage as a job benefit, leaving families to fend for themselves in a market of rising premiums and discrimination against the most vulnerable.

“Middle income Americans are now experiencing the human suffering that comes with being uninsured. It makes any illness a potential economic and social catastrophe,” says Dr. Steffie Woolhandler, of the Harvard Medical School, a co-founder of Physicians for a National Health Program.

Yet politicians keep tinkering with the current system. Of all the Presidential candidates for ’08, Dennis Kucinich is the only one proposing a single-payer system to eliminate the one out of every three dollars spent on health care that goes to insurers’ overhead and profits.

But rumblings of revolt can be heard. In California,
a new statewide poll shows voters rejecting moderate health-care reforms proposed by Gov. Arnold Schwarzenegger and Democratic legislators and leaning, instead, toward a state-managed "single-payer" system.

But it will take much more public demand to overcome the largest lobbying expenditures in American history to keep the system as a cash cow for companies that profit from it.