The Medicare scam


At the WBKB Alpena Fox News Candidate Forum in July 2016, when asked if he supported either reforming or privatizing Social Security and Medicare, Jack Bergman said, “Reform of privatize Medicare, did I get that right? And Social Security? Well, number one, I believe that over the long term we need to privatize, ok.”

Privatization will turn over these monies to investors on Wall Street. As with any corporate structure, employees, stockholders, executives and chief executive officers, many who already earn millions, will get large payments from our money. What is left for us will be anybody’s guess. And our monies will be subject to stock market fluctuations, which makes our money non-secured. It’s safe now. So, why kick this hornet’s nest? It is the same old, same old adage, “You scratch my back, and I’ll scratch yours.”

So, let’s look at Medicare and the insurance industry. According to the Center for Public Integrity’s revealing research published June 2016, “Medicare Advantage Money Grab: Auditors: feds failed to rein in billions in over-billing by Medicare Advantage.” Congress created private Medicare Advantage health plans 11 years ago to help control health care spending for the elderly. This investigation found that billions of tax dollars are wasted every year through manipulation of a Medicare payment tool called a “risk score.” The formula is supposed to pay health plans more for sicker patients and less for healthy people, but often it pays too much. The government has for years missed opportunities to corral tens of billions of dollars in overcharges and other billing errors tied to abuse of risk scores. This is fraud and these companies know it.

Meanwhile, the growing power of the Medicare Advantage industry has muzzled many critics in Congress, and turned others into cheerleaders for the program. From 2008 to 2013, improper payments to these health care plans totaled nearly $70 billion. Since 2004, however, the risk score formula has largely operated as an “honor system,” despite criticism that many health plans have overstated how sick some patients are to boost their revenues. And, America’s Health Insurance Plans, the industry’s trade organization, said that “an ‘unconfirmed diagnosis’ in an audit doesn’t necessarily mean that the person doesn’t have the disease.” So, if testing finds that you don’t have appendicitis you might still have it? Hmmm. Medicare Advantage insurance companies include Aetna (earned $60.3 billion in 2015), Blue Cross-Blue Shield, Humana, Mutual of Omaha, State Farm, Thrivent, etc. So with all this blatant and ignored intentional fraud, Congressman Bergman, wish to give the total Medicare fund ($532,233,342,782 spent in 2015 alone), to Wall Street corporations?

There’s a lot of back scratching going on in Congress. Those of us, who have paid into this fund for decades, will get the shaft. Get some backbone and tell Bergman and Congress to leave Medicare alone, condemn these fraudulent companies, prosecute them, recover our monies, fine them, and send all those who conspired in this scheme to jail.

Gerry Niedermaier