The Affordable Care Act treats the health insurance industry as the whipping boy of the American economy. Consequently, it's not surprising to read this AP article querying whether or not insurers have found new ways to avoid the sick. Here's the rub
Ending insurance discrimination against the sick was a central goal of the nation's healthcare overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers. The insurance industry responds that critics are confusing legitimate cost-control with bias.This fall the ACA regulators are expected to issue a patient non-discrimination rule implementing ACA § 1557 that undoubtedly will side with the patient groups and put more regulatory pressure on insurers when the real problem is the ever rising cost curve.
Speaking of the cost curve, the Washington Post has one of its "iconic" two full page Sunday news articles about a motorized wheelchair and scooter scam that has been hammering Medicare for decades. The thing that puzzles the FEHBlog is why Medicare beneficiaries who don't need a wheelchair agree to participate in this scam. Here's the uplifting conclusion to the article
Today, even while the wheelchair scam is in decline, that same “pay and chase” system is allowing other variants of the Medicare equipment scam to thrive.If you build it, they will come.
They aren’t perfect. But they work. In Brooklyn, for instance, the next big thing is shoe inserts. Scammers bill Medicare for a $500 custom-made orthotic, according to investigators. They give the patient a $30 Dr. Scholl’s.
In Puerto Rico, the next big thing seems to be arms and legs. In one case there, two dozen companies billed Medicare for $5.3 million in prosthetic legs inside of a year. In many cases, their “patients” had no record of amputations in their medical history. Many of them didn’t even live in Puerto Rico. But Medicare paid for the legs.