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Corrupt Government Title: The Great American Rip-Off [entitlements fraud] And you know where theres a lot of waste, fraud, and abuse? Social Security, Medicare, and Medicaid. Medicare and Medicaid together account for about $1 trillion in federal spending annually, and estimates suggest that $1 out of ever $10 of that spending is fraud. Some estimates go much higher. We do not have a very good idea of exactly how extensive fraud in the system is, because the federal government has put a fair amount of effort into not knowing. According to Malcolm Sparrow, a Harvard professor of public management who studies medical fraud, the governments approach long has been backward: Basically, the audits theyre using on a random sample are nothing like fraud audits, he told The Nation. The difference between a fraud audit and a medical review audit a medical review audit, youre taking all the information as if its true and testing whether the medical judgment seems appropriate. You can use these techniques to see where judgments are unorthodox or payment rules have not been followed, but almost nothing in these methods tests whether the information you have is true. Which is to say, investigators are asking whether a certain treatment was in fact appropriate for what ails Mrs. Jones, not whether Mrs. Jones exists. This is a major criminal enterprise, one involving transnational crime syndicates looking for a better return than that provided by drug smuggling and the other familiar rackets. According to The Economist: What to do? On a dollar-per-dollar basis, the Department of Health and Human Services fraud-recovery units by most accounts do relatively effective work but do not do very much of it, having recovered less than $2 billion in fraud losses in fiscal 2016. And there were only 1,160 convictions in fraud cases in 2016, or barely one fraud conviction a year for every two staffers in the anti-fraud division. There might be some benefit to beefing up the conventional in-house anti-fraud investigations (Sparrow has suggested setting aside 2 percent of the budget to protect the other 98 percent), especially if the additional funds are used in support of more-intelligent investigatory approaches. But that does not seem likely to be sufficient. Without indulging in black-helicopter stuff, we should squarely face the fact that organized-crime syndicates are being permitted to use our medical entitlements to loot the Treasury, and that not very much is being done about that, which suggests the possibility only a possibility that there is political collusion in this at some level. Entitlement fraud involves enough money and enough diverse political interests 40 percent of the residents of Los Angeles County receive Medicaid to warrant a genuinely independent investigation. How about we ask Peter Thiel to get involved in that? Thiel, a friend of the Trump administration and of this magazine, is a Silicon Valley entrepreneur who cofounded PayPal. As a payment system, PayPal was a natural target for fraud artists, and it developed sophisticated anti-fraud protocols, some of which were incorporated into a subsequent Thiel business called Palantir, a powerful data-mining platform that is used by everybody from U.S. intelligence agents to police detectives, for tasks ranging from mapping out where IEDs are likely to be planted to more relevant to our immediate concern here identifying fraud. The Centers for Medicaid and Medicare Services have run a few tests in which they attempted to use the system to identify fraud, but it is not clear whether that has resulted in wider implementation. My request to the agency for information on this matter remained unanswered as of this writing. It should be understood that data mining isnt a substitute for intelligent analysis it isnt a black box that can be switched on and start spitting out the home addresses of fraudsters. It is a tool, but one that can be used effectively only by an intelligent and creative team of human analysts. Entitlement fraud is what security experts describe as an adaptive threat, meaning that it is a problem without a solution, because the problem mutates in response to every solution developed. But even problems that cannot be solved can be managed, and we desperately need better management here. The Lets Put a Businessman in Charge! school of public affairs has its limits, but lessons learned from technology companies experience with fraud prevention ought to be applicable here. Policing waste, fraud, and abuse is not going to solve our national fiscal problem, though a few hundred billion a year would be real money. But progress on that front might help solve one of our national political problems: the crisis of trust in our institutions. We spend a great deal of money on government and public services, and there is a general impression it is not inaccurate that much of that money is not well spent. Those Aston Martindriving welfare queens in Brighton Beach do not just cost us money they cost us that most precious of commodities in a free society: trust. For that reason as well as the billions of dollars at stake, our would-be health-care reformers ought to incorporate a hammer-and-tongs attack on entitlement fraud, and on fraud across federal spending generally, into their legislative agendas. The sooner the better. Post Comment Private Reply Ignore Thread Top Page Up Full Thread Page Down Bottom/Latest Begin Trace Mode for Comment # 5.
#1. To: Tooconservative (#0)
The author is being dishonest by not mentioning DoD spending,including foreign aid in both military goods as well as humanitarian spendiing. Not to mention just flat-out "buying friends" with "Uncle Sugar's Dollar".
He was writing an article about entitlement fraud. My only real complaint was he should have gone into more specifics to support his assertion. The result was more along the lines of persuasive rhetoric than of documenting the scale of entitlement fraud. Of course, he does say that, due to reporting restrictions for auditing, it's difficult to even know the true scale of the fraud that is occurring.
You don't think military excursions into areas that are none of our concern in order to keep unemployment down in highly-paid union jobs mostly in the NE and far left qualify as "entitlement spending"? Of course the unspoken aspect of this is while it is keeping highly-paid union jobs alive and well,it is also doing the same for corporate stock prices and dividends for the trust fund crowd and the moneymen/moneygurls that back the Dims. Maybe I am just too cynical in my old age,but I believe there is not one single spending bill put forth and voted on,or just snuck inside a budget request for something else that isn't deeply scrutinized first to make sure the "right people" benefit from the bill being passed. There is "doing the right thing for America" while I am whole-hardheartedly in support of,and then there is the "doing the right thing for me and my voting base and friends",which I think needs to be questioned more often and closely. And this goes double when the lives of American military personnel are put at risk as an essential part of the bargain. People enlist to defend the nation,not to defend corporate profits.
No. When people say the words "entitlement spending", they are not indicating foreign military adventures at all. Social Security, Medicare and Medicaid are not Pentagon programs.
#6. To: Tooconservative (#5)
And that makes them wrong.
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