Medicare Fraud, Abuse and Waste Movie Review

President George Bush proposed a two part strategy with initial implemented drug coverage to low-income beneficiaries coupled with a White House task force to develop a plan to reform Medicare (Health Policy, 2001). Under this plan beneficiaries with income 135% below the national poverty guidelines would be eligible for full prescription drug coverage and a sliding scale would be provided for those under 175% (Health Policy 2001).

The most controversial aspect of these proposals was whether or not Medicare should remain a public insurance that is managed by the federal government. Supporters felt that this program should continue existing programs in scope and nature while opponents claim that a program of this sort should exist in the private market. Proposals suggested that a national standard for drug benefits should be established with all beneficiaries being eligible for standard benefits and increased benefits being given to those who incur catastrophic expenses. The addition of a prescription drug benefit to Medicare, while providing seniors additional choices in how they receive their health services, is a critical modernization of the program.

In 2003 the Medicare Modernization Act (MMA) provided prescription drug coverage to Medicare beneficiaries. It is estimated that more than 40 million beneficiaries have chosen to enroll in this voluntary program since 2006 (Neuman & Cubanski, 2009).This Act provided two very important provisions the first being that beneficiaries with low income and assets would be provided with subsidies to offset costs. Under the second provision, the Act moved those beneficiaries who were dually covered by Medicaid and Medicare off of Medicaid and onto Medicare part D (Neuman & Cubanski, 2009). This avoided duplication of services thus reducing potential for waste.

Fraud, Abuse, and Waste

The size and complexity of the Medicare program has made it vulnerable to fraud, waste, and abuse. Fraud characterizes intentional acts of deception such as benefits paid for deceased patients or prescriptions written by deceased doctors. Waste describes the inaccurate payment for services including duplicate payments or overpayment of invoices. Abuse is the intentional use of the program outside of the way that is designed such as going to multiple physicians for multiple prescriptions. This often results in types of illegal acts or substance abuse.

All of these issues directly tie into the financial and social responsibility issues that need to be addressed. The elimination of fraud would increase the effectiveness of our healthcare system and ensure that our public health program is not a catalyst to a public health problem. In fact, Medicare fraud has been estimated to total 60 billion.....