Audits and the contracted companies
Jim DeWees
Description
Collection
Title:
Audits and the contracted companies
Creator:
Jim DeWees
Date:
1/11/2013
Text:
Hello again, I just have one more thought to put out there. This is something that all of us have probably thought about, but I have not seen anything in writing or anything discussed officially. Does anyone else have questions about HOW it could possibly happen that Medicare claims that they have paid BILLIONS in fruadulent cases. But this overpayment still appears to continue over and over. But yet, Medicare still contracts with the same companies that are paying out for fraudulent claims, or so they say. So how does it happen that a company, like NGS, Humana or whatever company who is contracted by Medicare, can still get paid to do bad work?
If we get this right, EVERY claim that National Government Services (the Anthem owned company that is contracted to pay the Medicare claims in some regions), NGS gets a portion of that claim as an administrative fee. I don't know exactly HOW much they get as a processing fee, BUT we know that NGS is making billions through the Medicare contract. NGS gets paid for EVERY claim they pay out!!! So, it only makes sense that they will pay as many claims as possible, just to make money. They probably don't care to look closely to see IF the claim is legitimate or not, because they get paid ONLY when they pay out on claims, or at least process the claim.
Now, after all this investigation, Medicare states that too many claims are being paid, and now Medicare is paying NGS to reclaim the funds, or to NOT pay the claims, and get the money back for these bad claims. AND now NGS is getting paid AGAIN to reclaim the funds that they were paid for paying. Does this all make sense??? It makes my head spin thinking about this.
In a private business, if you knew that some contracted partner was basically wasting money or throwing money away just so they could make MORE money, and they were caught doing this, would you fire them? Or would you pay them MORE to go back and get that money back? And still, they are paying bad claims, and then getting paid to take the money back.....
This is NOT being talked about, and makes NO sense how the same people that paid claims in error (if that is REALLY happening), are still being paid to keep doing this, and also being paid to basically be their own detectives and police to catch their mistakes and pay them for catching their own mistakes..... This is crazy, and needs to stop!! We need the help of some politicians and some vocal amputees to get involved and raise awareness to what is going on. Thanks again, Jim DeWees, CP (yes, as you can see, I am on a roll today, and not happy with what is going on in Prosthetics today.....and what is OUR leadership doing????)
If we get this right, EVERY claim that National Government Services (the Anthem owned company that is contracted to pay the Medicare claims in some regions), NGS gets a portion of that claim as an administrative fee. I don't know exactly HOW much they get as a processing fee, BUT we know that NGS is making billions through the Medicare contract. NGS gets paid for EVERY claim they pay out!!! So, it only makes sense that they will pay as many claims as possible, just to make money. They probably don't care to look closely to see IF the claim is legitimate or not, because they get paid ONLY when they pay out on claims, or at least process the claim.
Now, after all this investigation, Medicare states that too many claims are being paid, and now Medicare is paying NGS to reclaim the funds, or to NOT pay the claims, and get the money back for these bad claims. AND now NGS is getting paid AGAIN to reclaim the funds that they were paid for paying. Does this all make sense??? It makes my head spin thinking about this.
In a private business, if you knew that some contracted partner was basically wasting money or throwing money away just so they could make MORE money, and they were caught doing this, would you fire them? Or would you pay them MORE to go back and get that money back? And still, they are paying bad claims, and then getting paid to take the money back.....
This is NOT being talked about, and makes NO sense how the same people that paid claims in error (if that is REALLY happening), are still being paid to keep doing this, and also being paid to basically be their own detectives and police to catch their mistakes and pay them for catching their own mistakes..... This is crazy, and needs to stop!! We need the help of some politicians and some vocal amputees to get involved and raise awareness to what is going on. Thanks again, Jim DeWees, CP (yes, as you can see, I am on a roll today, and not happy with what is going on in Prosthetics today.....and what is OUR leadership doing????)
Citation
Jim DeWees, “Audits and the contracted companies,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/234456.
