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Started By
Message
re: CMS Finds 2.8 Million Americans Potentially Enrolled In Two or More Medicaid/ACA Exchange
Posted on 7/21/25 at 10:23 am to udtiger
Posted on 7/21/25 at 10:23 am to udtiger
quote:
General Medicaid fraud has nothing to do with the the subject of the OP, or my response.
Just adding to the general conversation about medicaid.
Sorry to bother you.
1
Posted on 7/21/25 at 10:28 am to FATBOY TIGER
quote:
Just adding to the general conversation about medicaid.
Sorry to bother you.
Not bothering me at all.
Medicare, Medicaid, S-chip, etc. are all terrible, have completely fricked the marketplace, and are unconstitutional to boot.
Posted on 7/21/25 at 10:31 am to Reubaltaich
“But having as many free healthcare plans as they want is a right.” 4cubbies
Posted on 7/21/25 at 10:37 am to udtiger
quote:
Medicare, Medicaid, S-chip, etc. are all terrible, have completely fricked the marketplace, and are unconstitutional to boot.
Truth. They pay for shite. They are administrative nightmares to deal with leading to higher overhead for providers, not to mention tons of bullshite regulation and audits that apparently do mf'ing zero to curb fraud.
At the same time, all that gov't cheese and mandated overhead drives up drug and healthcare prices. This give private insurers a buffer to rape and pillage consumers as they can no longer afford to not have insurance, no matter how shitty or expensive. Lost cost, high deductible plans no longer exist and the deductibles would be insanely high compared to pre-Obamacare. We need MAJOR insurance reforms.
People blame doctors, pharmacists etc when in fact our re-imbursement is less than it was 20 years ago while the costs of business has exploded. Meanwhile, private insurers/PBMS have been setting record profit every year for 20+ years. Trump just needs to make me his insurance Czar, get me some of that protection he and Elon have and let me feast on the waste, fraud and regulation. You have to know the system to attack it. The people in charge do not know or understand the system or are bought off by it.
Posted on 7/21/25 at 10:44 am to Reubaltaich
They could clean up Medicare, SS and Medicaid….and the ACA …and probably extend the life of these programs 20 years.
Posted on 7/21/25 at 10:57 am to Scruffy
“I am curious how Drs.and hospitals are at fault here”
I’m not speaking to Medicaid but I was a nurse before DRGs and Medicare paid close to 100% of charges. Drs. and hospitals milked it for all it was worth.Nobody died a natural death,pts. reached their expiration date from old age,heart failure,cancer,whatever,they were transferred to ICU and kept alive for as long as possible.Vents,drugs,etc.Then as FATBOY TIGER complained about his grandfather’s situation run all kinds of bullshite tests,x-rays,etc.
It was really disgusting and I often felt ashamed for participating.I do remember thinking this is not sustainable,we were only one hospital and I was sure all hospitals were doing the same.
The only reason I was able to stay was we had large number of pts.with acute illnesses or injuries that we were able to save and return to a normal or somewhat normal life.
I’m not speaking to Medicaid but I was a nurse before DRGs and Medicare paid close to 100% of charges. Drs. and hospitals milked it for all it was worth.Nobody died a natural death,pts. reached their expiration date from old age,heart failure,cancer,whatever,they were transferred to ICU and kept alive for as long as possible.Vents,drugs,etc.Then as FATBOY TIGER complained about his grandfather’s situation run all kinds of bullshite tests,x-rays,etc.
It was really disgusting and I often felt ashamed for participating.I do remember thinking this is not sustainable,we were only one hospital and I was sure all hospitals were doing the same.
The only reason I was able to stay was we had large number of pts.with acute illnesses or injuries that we were able to save and return to a normal or somewhat normal life.
Posted on 7/21/25 at 11:00 am to LSUA 75
quote:What year was this because Medicare/Medicaid pays something like 80% of charges, and that might even be higher than it really is.
I’m not speaking to Medicaid but I was a nurse before DRGs and Medicare paid close to 100% of charges.
It was 80% ten years ago.
It also has been declining steadily.
How many decades ago were you working?
This post was edited on 7/21/25 at 11:04 am
Posted on 7/21/25 at 11:28 am to SmackoverHawg
“ our reimbursement is less than it was 20 years ago”.
That’s very true,I have always had connections to be able to find out physician charges for various surgeries,It’s mind boggling how much less CV surgeons are reimbursed,same for cataract surgeries,esp when inflation is factored in.
Guess they are paying for the sins of their predecessors with their unfettered greed,
A certain amt.of fraud went on also.A cardiologist in Lafayette went to prison for doing unnecessary stents.I remember a story about a hospital in Northern California where unnecessary bypasses and stent placements were being done,with the blessing of the hospital.
That’s very true,I have always had connections to be able to find out physician charges for various surgeries,It’s mind boggling how much less CV surgeons are reimbursed,same for cataract surgeries,esp when inflation is factored in.
Guess they are paying for the sins of their predecessors with their unfettered greed,
A certain amt.of fraud went on also.A cardiologist in Lafayette went to prison for doing unnecessary stents.I remember a story about a hospital in Northern California where unnecessary bypasses and stent placements were being done,with the blessing of the hospital.
Posted on 7/21/25 at 11:33 am to Scruffy
“How many decades ago were you working?”
I graduated Dec.1975,my first full year was 1976.
I graduated Dec.1975,my first full year was 1976.
Posted on 7/21/25 at 5:12 pm to LSUA 75
quote:
Guess they are paying for the sins of their predecessors with their unfettered greed,
No. This is insurance greed. From what I've seen, poor reimbursement leads to more fraudulent claims and unnecessary services. There is fraud in every field. We sort out the bullshite pretty well, it's not our fault it takes the feds so long to act.
Talent is retiring early and the younger replacements aren't nearly as good or motivated.
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