Not a Small Fraud Problem

 Over on X, I have been seeing TDS sufferers complaining that allegations of Medicare fraud are overblown and are just a small number of bad actors. The scale of bad actors matters.

5/14/26 CBS News:

The owner of a healthcare software company was convicted of massive Medicare fraud on Thursday, the Department of Justice said, ending what Acting Attorney General Todd Blanche called "one of the most egregious fraud schemes in Florida history." ...

Blackman and his co-conspirators billed Medicare and other federal healthcare benefit programs over $1 billion throughout the course of the scheme, the Department of Justice said. Medicare and the other programs paid out more than $450 million.

Capable of Learning

Planaria and Idaho legislators are capable of learning. After the Dobbs decision, Idaho like many other states prohibited abortion. Because of how they wrote the law, some non-abortive procedures such as D&C after miscarriage or where there was no fetal heartbeat became illegal.  Ob-Gyns deserted Idaho rapidly because they perceived a very real risk that these procedures might lead to prosecution.  

Why did they write the law this way? Because pre-Roe, there were states that banned abortion like Oregon that had astonishingly high rates of "therapeutic abortions" to save the life of the mother: in one of those years, there were 166 such abortions for every 1000 live births. I am guessing that many ob-gyns were doing abortions to save Mom and Dad from the embarrassment that Janie was sweet talked out of her clothes by some clever predator. 

Anyway: this is not the first time bad writing has needed correction. In 1776, New York State made Sodom a capital crime. The next year, they revised the statute to clarify that this only applied to consensual sodomy. I wonder if some really horrible case raised such an issue.

So I was curious is this was fixed. SuperGrok, was this fixed?

‐‐----------

Yes, Idaho revised its abortion law in 2023 (effective July 1) to explicitly clarify that certain non-abortion procedures, including D&Cs for miscarriages or incomplete pregnancies, are not considered abortions and are therefore allowed.132b99

Key Details from the Amendment (to Idaho Code § 18-622 and related definitions in § 18-604)

The legislature amended the definition of "abortion" to exclude:

The removal of a dead unborn child (this covers D&Cs or similar procedures after a miscarriage or fetal demise where there is no cardiac activity).

The treatment of a woman who is no longer pregnant (this addresses post-miscarriage care or incomplete abortions/miscarriages).

Removal of an ectopic or molar pregnancy.

Contraception (e.g., IUDs or birth control pills).5de97a

This was done via House Bill 374 (2023), which shifted some prior "affirmative defenses" into clearer exclusions from the definition of abortion. Medical sources (e.g., Abortion Defense Network summaries) confirm this means treatments for miscarriage with no cardiac activity—including medications, D&C, D&E, or labor induction—are not prohibited under Idaho's abortion bans.6ddc46

Context and Limitations

Pre-2023 concerns: After Dobbs (2022), Idaho's near-total ban (the "Defense of Life Act," triggered post-Roe) created uncertainty for providers. Some feared that D&Cs (a common procedure also used in abortions) could be interpreted as illegal abortions, even for miscarriages. The 2023 fix addressed this by narrowing what counts as a criminal "abortion."b59188

Ongoing strictness: The core ban remains—one of the strictest in the U.S.—with abortions generally prohibited except to prevent the death of the pregnant woman (in good-faith medical judgment) or in limited first-trimester rape/incest cases (with reporting requirements). Court rulings have somewhat broadened the life exception (e.g., non-imminent but elevated risk of death), but it does not cover general health exceptions or fatal fetal anomalies unless they threaten the mother's life.26232a

Practical notes: Providers still emphasize careful documentation. Some patients have reported delays or transfers for miscarriage care due to caution, but the law itself now clearly permits indicated D&Cs for non-viable pregnancies.9a0b19

In short, the 2023 revision directly responded to ambiguities around procedures like non-abortion D&Cs by carving them out of the abortion definition. For the most current interpretation, consult the full Idaho Code or a qualified attorney, as enforcement can involve case-by-case medical judgment.

Fraud? No, Just Excellent Health Care

4/2/26 CBS News:

The FBI arrested a married couple Thursday accused of fraudulently billing Medicare for $7.45 million while running a hospice with a survival rate reported to be more than 97% after five years. They were the first in a series of arrests planned Thursday, federal officials told CBS News.

A high survival rate at a hospice provider is one of a series of red flags identified by state auditors for fraud because most people enter hospice care in the final stages of a terminal illness. In past cases of fraud, operators were found to be using false or stolen identities to collect federal reimbursements for palliative care.

This depressing chart shows more than $1 trillion dollars of Medicare spending in 2024. Other coverage reports that the task force examining this hospice fraud was named "Never Say Die."

You wonder how much of our hopeless deficits might disappear if the fraudsters were defanged.  Also, how many people in need of medical care are shunted aside by the fraudsters.

Alternative Explanations

 8/25/25 Federalist discusses evidence of fraud in both Obamacare programs and Medicaid:

The first data point came via the federal Centers for Medicare and Medicaid Services (CMS), which released data from exchange insurers’ risk adjustment submissions. The spreadsheet contains enough numbers to make one’s head spin, but two sets of numbers — lines 4 and 7 of the spreadsheet — stand out. Those two lines show that the percentage of enrollees in Bronze and heavily subsidized Silver plans without claims rose from roughly one-quarter (29 percent and 23 percent, respectively) in 2019 to 40 percent last year.

To some, that change may not seem like a big deal — after all, isn’t it a good thing when people don’t make claims on their health coverage? But it suggests that, after four years of Biden administration policies, a growing number of individuals were being auto-enrolled (and/or automatically reenrolled) into taxpayer-funded “free” health coverage that they did not want, need, or use.

Indeed, the spreadsheet shows that 39% of enrollees made no claims in 2024.  There is another explanation.  The deductibles on these plans are enormous.  The weighted average for 2024 was about $2700.  If you are a typical young person, you might well have such a small need for medical care that you decide to not make a claim unless you expect to meet the deductible; you may also take advantage of lower costs from self-pay.  Indeed, one of the reasons that ACA mandated insurance for all was that young people would not enroll, because of a perceived lack of need.  This would make insurance for older people even more prohibitive than it is.

Another part of the article is more concerning:

According to the auditor’s report, from February 2019 through this March, Louisiana paid at least $9.6 million providing Medicaid coverage to 1,072 beneficiaries after their date of death. Because Louisiana, like most states, runs its Medicaid program through managed care organizations, those insurers get paid per month for every enrollee, whether the enrollee sees the doctor or not. If the state Medicaid agency does not properly report a beneficiary’s death, the insurer will get paid in perpetuity for “covering” that dead enrollee.

That’s exactly what happened in Louisiana. For the cases examined, insurers were paid a median of 418 days — that’s nearly 14 months — after the beneficiary had died. For the 168 deceased beneficiaries the auditor identified via the Social Security Death Master File, insurers had been receiving payments for a median of 799 days — more than two years.

Saving Medicaid for Lawful Residents

The OBBB has a number of Medicaid cuts.  One of them cuts illegals off Medicaid.   You think this is odd?  We must assume that Medicaid is paying for illegals, because 20 states are now suing to be excused from providing Medicaid information to ICE.  7/1/25 Denver Post:

"Colorado and 19 other states sued the federal government Tuesday to prevent Medicaid data from being used for immigration enforcement.

"In June, the Department of Health and Human Services transferred data about people enrolled in Medicaid to the Department of Homeland Security, which includes Immigration and Customs Enforcement. The shared data included names, addresses, Social Security numbers, immigration status and information about medical claims made by residents of California, Illinois, Washington state and the District of Columbia."

Now, if you want to argue that illegal aliens deserve medical care, there is a plausible argument founded in a Christian commonwealth's duty to care for the poor.  But advocates for this point of view usually get pretty insistent that this is a secular society that barely tolerates Christianity (as long as you bake that cake!).  

Another argument is that providing care to the poor requires some care to make sure it is spent wisely.  Spending it on people who are not lawfully here seems unwise.

Most Favored Nation Drug Prices

 Trump is demanding that pharmaceutical companies charge Americans the price that they sell the drug in other countries--actually the lowest price globally.  5/12/25 CNN raises a legitimate question.  Under what authority can Trump force them to do so? 

It appears that Trump tried this on his first term through a process over which the federal government clearly has authority (Medicare reimbursement) but the Democrats stopped him:

Trump’s effort to establish a “Most Favored Nation” rule for certain drugs in Medicare during his first term was quickly blocked by federal courts for procedural reasons before being rescinded by then-President Joe Biden in 2021. The new executive order goes far beyond that measure since it is not limited to Medicare nor to a certain number of drugs.

Of course,  Big Pharma owns the Democrats.   Next time your leftist friends whine about Trump looking out for the rich, remind them about this.

Why Can't We Have Socialized Medicine Like Canada?

3/13/25 Winnipeg Sun:

"The death of Debbie Fewster in October while waiting for triple-bypass surgery is a shameful indictment of a bloated health care system that treats patients like inventory. Doctors and nurses know that patients aren’t given a fighting chance to save themselves, and health authority administrators and Manitoba Health neglect to collect the data that would tell us how widespread the fatalities are...

"A police officer asked what happened and when she learned Debbie was on a waiting list for heart surgery, the officer told

Daniel “you’d be shocked how many calls we get like this, people desperate for surgery but the health authority can’t get to them in time,” and that she too, had lost two family members waiting on lists....

"

According to his group’s annual “Died on a Waiting List” report, Ontario had 115 patients die waiting for cardiac surgery, with 41 having occurred to patients suffering past the recommended wait time.

In 2022-23 Nova Scotia reported 532 deaths of those on surgical wait lists, with 50 of those waiting for life-saving surgery and 19 of those being beyond the recommended wait time."

I waited three weeks for non-emergency open-heart surgery.  Why Canadians put up with this eludes me.

This Degrades the Meaning of the Word

12/17/24 National Public Radio:

NEW YORK — The man accused of killing UnitedHealthcare's CEO has been charged with murder as an act of terrorism, prosecutors said Tuesday as they worked to bring him to a New York court from from a Pennsylvania jail.

Luigi Mangione already was charged with murder in the Dec. 4 killing of Brian Thompson, but the terror allegation is new.

Under New York law, such a charge can be brought when an alleged crime is "intended to intimidate or coerce a civilian population, influence the policies of a unit of government by intimidation or coercion and affect the conduct of a unit of government by murder, assassination or kidnapping."

Insurance companies are not governments.  Intimidating insurance companies or their CEOs are not "a civilian population" unless there are a lot more insurance company CEOs than I think.  It is already bad enough that he is becoming a hero to the left.  Charging him as a terrorist will just make him more popular with the blue-haired, heavily pierced and tattooed crowd.

I Thought Obamacare Was Going to Solve Our Healthcare Crisis

12/15/24 Independent:

Luigi Mangione supporters have donated tens of thousands of dollars to “defense funds” set up for him after he was arrested on suspicion of murdering UnitedHealthcare CEO Brian Thompson.

The anonymous fund “December 4th Legal Committee” surpassed more than $100,000 in donations on the crowdfunding website GiveSendGo by Sunday morning.

The group’s name is an apparent reference to the day the 26-year-old allegedly gunned down the healthcare executive on a busy Manhattan street.

This Place is Turning into Extreme Northeastern California

My wife was having some odd symptoms.  Urgent Care went ??? And sent her to ER.  We waited 90 minutes to get her into a bed.  For those who live in much of California, this is pretty fast.  (I have bad memories of California ERs.)

Too many people have escaped to here and most of them are old enough to recognize that California is a giant cesspool but because of age they are high users of medical care.

Salivary gland stone.  I never heard of this before.

Perspective: Don't Panic

Some historical perspective.  The 1918 influenza epidemic had a 2.5% mortality rate.  So far the U.S. coronavirus has a 2% mortality rate.  Gina Kolata’s Flu examines why it was so disruptive.  Unlike most strains, which primarily killed young and old, the 1918 strain killed young adults, causing great disruption to operation of the society.  Coronavirus is mostly killing elderly and other immune-compromised populations.   These are individual tragedies, but our society survives tens of thousands of flu deaths each year, mostly of older people.  Europe is hard hit because it has a much older population than the U.S.  

 Smoking is likely a contributor; China produces and consumes 30% of the world’s cigarettes.  This list of cigarettes consumed per year per person is dominated by European nations.

Medicare For Everyone?

The left are screaming for Medicare for everyone.  My experience with Medicare and my Medicare Advantage plan so far had been absolutely wonderful.  I would not mind it being open to everyone as long as they pay the actual costs.  I'd you are my age, you have paid into the program through paycheck withholding for decades.

Want to join?  Then pay your share of decades of costs and then the monthly premiums. I suspect this would become a far less attractive idea.

Yes, I have seen many doctors who refuse Medicare, some of whom have told me the government needed to do something.  "Do you take Medicare patients?"  "No."

Partially Blocked Small Colon

No, it is not the name of a 1980s punk band.  I woke up at 2:00 AM with a distended and painful stomach.  In the ER AT 7:00. AM I thought it was food poisoning, but I could not vomit.  CAT scan showed a partially blocked small colon.  I am in the hospital.  The goal is to see if the lower bowel turns its self around, so wet can avoid surgery.  I am beginning to pass gas, and I can feel stuff moving into my intestines. I may be out tomorrow.

MONDAY update: Waiting for the paperwork to be completed and then I go home.

Once again, St. Alphonsus' Medical Center was showing their Jesus.  As usual not just caring, but profoundly caring employees.  Even Julio who wheeled me downstairs for abdominal X-ray was deeply concerned about my comfort, as was Marisa, the day shift RN, and Olga, the day shift CNA.  (I cannot remember the names of the night shift RN and CNA, but also wonderful and caring people.)   The gal from food services, who I suspect is not well paid, did an exemplary job of not only ordering my meals (which were at first only clear liquids) but also showing concern for my medical condition.  I have not ever had what I would call a bad experience at St. Luke's, their Protestant competitor here in Boise, but St. Al's just go above and beyond my expectations.

The trauma surgeon who came up to discuss possible surgery was also a caring person.  The guy was Trauma Services who up after the X-rays, ditto.  "The good news is you do not need a surgeon."  And a sense of humor: "A surgeon stabs you until you get better."

If you know someone who works for St. Al's, please share this with them.

California Is Doubtless Looking Out for Future Voters

Fox News reports on California's $214.8 billion budget:

The budget includes money to give taxpayer-funded health insurance to some low-income illegal immigrants. It also authorizes $2.4 billion in spending to address the state's housing and homelessness crisis....

That isn't the craziest part:

The state would give $650 million to local governments to tackle homelessness and pump $500 million into a tax credit program to spur construction of residential rental units.Lawmakers would spend $5 million on grants to homeless shelters so they can accommodate pets.

If you do not have a home, you do not need us to care for your pet.  Priorities!

Doing Jesus' Work

5/31/19 USA Today has a heartwarming story about people deep in medical debt.  Churches are paying off these debts for those who lack the resources to do so and using a very clever way of doing it on the cheap:

A big part of RIP’s appeal comes from the impact even a small donation can have, say participating church leaders. When a person can’t pay a bill, that debt is often packaged with other people’s debt and sold to bill collectors for some fraction of the total amount of the bill. Those debts usually come from low-income people and are more difficult to collect.

RIP Medical Debt buys debt portfolios on this secondary market for pennies on the dollar with money from its donors. But instead of collecting the debt, RIP forgives it.

I know that many people who go into bankruptcy from medical debt often have other factors in play: gambling problems, substance abuse, and failure to obtain medical insurance when they had it available. 

Saving people from past stupidity is a lot like grace: God forgives us of our sins, even big ones, when we accept Jesus Christ as our Savior.  If you keep throwing yourself back into sin, it will catch up with you again.  But think of this as a "Get Out of Jail" card from Monopoly.  And churches are doing God's work when they help with a crisis like this.  I think that I will let my pastor know about this.

Medical providers at least get some of their unpaid bills covered: better than nothing.

A Year Ago, I Had a Student Who Was a Graduate of Evergreen State College

That should tell you enough right there.  He dropped the class and told the department chair that I was politicizing history.  I had referred to the struggle between elites and the masses in American history.  When he challenged what I considered elite ideas, I mentioned the National Health Service in Britain and gun control.  He engaged in a vigorous defense of the NHS, which he claimed to have extensively studied.  I mentioned that British papers have reported on thousands of patients starved to death in NHS hospitals.  Because he didn't believe it, I brought the articles, which quoted government officials admitting it.  He dropped the class shortly afterwards.  4/15/19 [U.K.] Mirror (a tabloid, what the masses read):

Man with Down's Syndrome's 'cruel and horrific' death after 19 days without food

Giuseppe 'Joe' Ulleri wasted away at Manchester Royal Infirmary after the 'failure in his overall care'

2/2/19 Mirror:

Hospital patients die from starvation and thirst because nurses are over-stretched

But this week it was revealed that three patients a day are dying from starvation or thirst or choking on NHS wards. 

1/9/17 [U.K.] Independent:

Two patients die from starvation or thirst each day in UK hospitals and care homes, say statistics

Cash Discounts

We are processing the bills from Rhonda's recent surgery.  While we will get reimbursement from Christian Healthcare Ministries in about 120 days, I find myself imagining CHM's average member having to carry $5,000 or so for 120 days.  I suspect that they end up with enormous credit card balances for a few months.  St. Alphonsus's Emergency Room gave us a $1227.49 uninsured discount on a $4091.65 bill, and we paid part of the bill up front.  The anesthesiologist's bill was $2250, but paying it by Discover card just after the bill arrived, they gave us a $1350 discount.  (I suspect that is what many insurance companies pay for this service.)  Probably many uninsured either do not pay or take many months to pay in full.

The good news is that our Discover cashback bonus is substantial.  And I am so glad we paid off both car loans and the mortgage: a $2100 increase in cash flow.

Health Insurance Coverage

I saw claims about what percentage of Americans have health insurance, but I have learned that when you see claims made with which you agree, it is always best to check the original source.  The Census Bureau gathers data on poverty, family income, and insurance coverage. You may recall Re. Nancy Pelosi (D-LaLaLand) claiming that record low unemployment levels being not meaningful because so many Americans were injured by alterations to Obamacare.  Those changes happened in 2017.  The Census Bureau reports:

At the same time, the number of people without health insurance coverage and the uninsured rate were not statistically different from 2016....

The percentage of people without health insurance coverage for the entire 2017 calendar year was 8.8 percent, or 28.5 million, not statistically different from 2016 (8.8 percent or 28.1 million people). Between 2016 and 2017, the number of people with health insurance coverage increased by 2.3 million, up to 294.6 million.

If Obamacare was supposed to fix the problem of being uninsured, it obviously did not succeed, and the piddly changes made by Congress in 2017 made nothing worse.

Democrats will also be disturbed to learn:

Median household income in the United States in 2017 was $61,372, an increase in real terms of 1.8 percent from the 2016 median income of $60,309. This is the third consecutive annual increase in median household income.
The nation’s official poverty rate in 2017 was 12.3 percent, with 39.7 million people in poverty. The number of people in poverty in 2017 was not statistically different from the number in poverty in 2016. The 0.4 percentage-point decrease in the poverty rate from 2016 (12.7 percent) to 2017 represents the third consecutive annual decline in poverty.  

Still Trying to Figure Out How This Gal Can Be This Stupid and Feed Herself

8/8/18 CNN interview with Alexandria Ocasio-Cortez:

CORTEZ: So, first of all, the thing that we need to realize is people talk about the sticker shock of Medicare for all. They do not talk about the sticker shock of our -- of the cost of our existing system. 

You know in a Koch Brothers-funded, you know, study, if any study's going to try to be a little bit slanted, it would be one funded by the Koch brothers. It shows that Medicare for all is actually much more -- is actually much cheaper than the current system that we pay right now. 

And let's not forget that the reason that the Supreme Court upheld the Affordable Care Act is because they ruled that each of these monthly payments that everyday American make is a tax. And so, while it may not seem like we pay that tax on April 15th, we pay it every single month or we do pay at tax season if we don't buy, you know, these plans off of the exchange. 

So, we're paying for this system. We -- Americans have the sticker shock of healthcare as it is, and what we're also not talking about is, why aren't we incorporating the cost of all the funeral expenses of those who died because they can't afford access to healthcare? That is part of the cost of our system. [emphasis added]

It appears that Medicare recipients never need funerals.  My, that's a relief!  I am never going to die!

Perhaps she means premature deaths, but even then, "no one get out of here alive."   Is no one on the left even a little embarrassed by this idiocy?

Real Efforts at Health Care Reform

8/3/18 The Hill:

Hospitals will be required to post online a list of their standard charges under a rule finalized Thursday by the Trump administration.

While hospitals are already required to make this information public on request, the Centers for Medicare and Medicaid Services (CMS) said the new rule would require the info be posted online to "encourage price transparency" and improve "public accessibility."

Starting Jan. 1, hospitals will be required to update the information annually.

The CMS said it is also considering how to "allow consumers to more easily access relevant healthcare data and compare providers."

Competition in health care as a way of cutting costs?  Why didn't the Democrats think of this?  That's right, their goal wasn't reducing costs.