Your tax dollars at work

This is what happens when you have a weak claim sysyem and weak utilization control. Isn’t it incredible that this could go on for years undetected.

Assistant U.S. Attorney Alexandra Chase told a federal jury during closing arguments that Dr. Salomon Melgen, 62, repeatedly performed unnecessary tests and treatments on his mostly elderly patients to “line his pockets.” He faces the equivalent of a life sentence if convicted of all or most of the 76 counts against him. Prosecutors say he stole up to $105 million between 2008 and 2013.


  1. You think it is bad now. Just wait until we have a single payer healthcare system. I would bet you they are only finding about 20% of the fraud and they don’t really care, because it is not their money.


  2. My wife worked for a large medical insurance company for many years. She knew that a Medicare patient was good for 28 days in the hospital without anyone checking. When the 26 day was approaching the hospital would notify her company that they would be responsible soon for paying for treatments. She had case load of up to 50 patients, she would review their charts everyday, make arrangements for care at home (cheaper) and not pay the hospital for unnecessary treatments.
    Who is doing this for Medicare?


    1. That’s the problem. Medicare follows a pay and pursue policy and does very little concurrent utilization review, if any. And, that’s also one reason they claim low admin costs which is counterproductive.


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