Staying Fit
l Fraud and waste are the Bonnie and Clyde of American health care, robbing the system of money that would be far better spent making sick people well. Although fraud is the flashy attention-getter, it is waste layered throughout the system that is making off with the most money.
Unfortunately, waste is hard to find and even harder to fix, sometimes hiding in plain sight. The cumulative cost is staggering. Of the $2.5 trillion the United States spent on health care in 2009, an estimated $750 billion was wasted on medical errors, uncoordinated care, inflated prices, excessive testing and missed chances for preventive health care, according to Institute of Medicine data. That did little or nothing to make Americans healthier.
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As inspector general, I direct an office that searches for waste and fraud in the 300 programs under the U.S. Department of Health and Human Services, primarily in Medicare and Medicaid, which together finance health care for more than 100 million Americans.
Last December my office released a study that shows Medicare and its beneficiaries paid more than four times the cost of the most commonly ordered lower-back brace. Medicare paid an average of $919 for a brace that cost suppliers an average of $191. The price was supposed to include fitting, yet in one-third of the claims, this was not provided. Ultimately, taxpayers paid $37 million more for these braces than suppliers paid to acquire them.
Adverse medical events such as infections and overmedication often waste health care dollars and, far more important, harm patients, including one of every four hospitalized Medicare patients. These events contribute to an estimated 180,000 deaths each year and cost Medicare more than $4.4 billion a year. Our research shows that nearly half of these events are preventable.
This is a complex problem. Permanent solutions require the help of lawmakers, medical professionals and patients — yes, patients.
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