That's true to an extent, and those minimal controls are why Medicare also wastes billions on paying fraudulent claims.

https://relentlesshealthvalue.com/episode/ep502-how-some-pre...

da_chicken 2 hours ago | parent | next [-]

They waste billions on fraudulent claims because they don't fund the program well enough to have compliance enforcement or auditing.

Also, I'm not going to trust a podcast owned and operated by Stacey Richter, who also just so happens to be the co-president of Aventria Health Group and QC-Health.

	▲	AnthonyMouse an hour ago \| parent \| next [-]
		> They waste billions on fraudulent claims because they don't fund the program well enough to have compliance enforcement or auditing. These are synonyms for having higher overhead, right? If you pay a billion dollars in claims with ten million dollars in administrative costs then your "administrative overhead" is 1%, even if half the claims are fraud. If you increase "administrative costs" to a hundred million to get rid of the fraud, in practice you just saved 410 million dollars but now your "administrative overhead" is up to 20%.
	▲	nradov 2 hours ago \| parent \| prev [-]
		Trust is irrelevant. You can verify all of the statements made by Brian Machut on that podcast with independent sources if you like.

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Projectiboga 3 hours ago | parent | prev [-]

Yes but the Medicare and Medicaid reimbursement rates are below breakeven so cash and insurance rates have to be above provider breakeven. The main cost frictions are administrative costs for billing on both the insurance and provider sides.

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nradov an hour ago | parent [-]

That's true to an extent, but some provider organizations manage to survive with patient populations that are almost entirely Medicare / Medicaid. Many provider organizations are just badly managed and haven't taken steps to optimize their finances through automation or participation in value-based care programs.

	▲	lupire 25 minutes ago \| parent [-]
		See the above comment about fraudulent billing for non-existent illnesses that don't need treatment.