How often have you heard a politician compare the admin costs of Medicare with private insurance. They say it’s low cost a good thing; it’s not.
Medicare does not adequately manage health care claims and below is a small example of what it leads to.
In 2017 it’s estimated that Medicare lost $60 billion to fraud or about 10% of total claims, but the actual number is unknown and has been estimated to be as much as 30% of claims. It’s no wonder as Medicare is prevented by law from scrutinizing claims the way private insurance does. There are always consequences to political decisions.
Kenneth Felder and his New York-based ophthalmology practice Metropolitan Retina Associates agreed to pay close to $2.1 million to the US government to resolve a civil fraud lawsuit accusing them of violating the False Claims Act and defrauding Medicare and Medicaid. The settlement resolves allegations that Felder and his practice submitted fraudulent claims to Medicaid and Medicare for substandard or worthless fluorescein angiography tests and undocumented or unprovided ophthalmic ultrasounds.