Review: "More Whistleblowers Say Health Plans Are Gouging Medicare" – NPR
I'm more concerned that people are surprised by this than I am that it is actually happening. Read the NPR Blog post.
Medicare is a bloated, inefficient system that has so many rules and regulations that I don't even try to think about it because it would ruin my day and keep me from the joys of patient care. Medicaid and the VA system are equally as bad. Good intentions, terrible execution.
It's strange to me that we'd create government programs, then turn around and pay a private company to "manage" them. And then allow the private company to make up their own arbitrary rules to deny and limit care so that they can keep even more of the money that the government gives them. Really?
And then patients get upset because no providers wish to deal with this absolute nonsense way of running a system.
I commend whistleblowers at the various health insurance companies for stepping up and saying, wait a minute, we pay into this system and we're watching us scam ourselves. Because of the incentive structure of health insurance and our health care delivery system, these abuses of said system will only continue to happen.
In P.S.Y.C.H., there's no need to scam the system, though I'm sure someone will try. Because it's run as a non-profit company with transparency and accountability to all shareholders (a state's citizens), there is very little wiggle room to scam the masses when they're paying attention to what you're doing.