Subsidies, Fraud, and the Healthcare Trap: Medicare, Medicaid, ACA & the Battle to Fix It | World of Payne
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概要
- How Medicare really works (Part A, B, C, and D) and how Medicare Advantage risk-score gaming is costing taxpayers tens of billions while driving corporate profits.
- Why Medicaid has become both a lifeline and a loophole, with states gaming federal matching funds (FMAP), hospitals recycling money, and managed care plans inflating costs.
- How ACA subsidies (Obamacare) impact premiums and dependence, from income-based tax credits to the "cliff removal" that quietly expanded government responsibility for healthcare costs.
- The administrative hydra: coding chaos, prior authorizations, bloated billing departments, and a paperwork machine that consumes 25–30% of all U.S. healthcare spending while doctors and nurses drown in documentation instead of caring for patients.
- A hard-hitting exposé on healthcare fraud and abuse:
- Durable Medical Equipment (DME) scams and fake suppliers
- Home health and hospice fraud
- Upcoding, ghost patients, and falsified diagnoses
- Medicaid managed care manipulation and state-level loopholes
- ACA marketplace gaming, income manipulation, and hospital steering
- Organized crime and international fraud rings targeting Medicare and Medicaid
- Administrative simplification: fewer codes, a national claims standard, real interoperability, and a serious overhaul of prior authorizations.
- Severe crackdowns on fraud: real-time AI auditing, criminal charges for large-scale fraud, stronger whistleblower protections, and public transparency dashboards so taxpayers can finally see where the money goes.
- Redirecting subsidies toward people rather than institutions through personalized health accounts, direct primary care, and price transparency that empower patients to make informed choices.
- Medicaid reform that protects children, people with disabilities, and low-income seniors while closing FMAP loopholes, tightening eligibility appropriately, and linking non-disabled adults to work and training where it makes sense.
- Medicare reform focused on reining in Medicare Advantage risk-score gaming, enforcing site-neutral payments, and making benefits more straightforward, more transparent, and less exploitable.
If you believe we can have compassion without corruption,
If you want a brutally honest but hopeful conversation about Medicare, Medicaid, the ACA, healthcare fraud, and real reform— this World of Payne episode is for you. 🔊 Listen in, share it with a friend, and be part of the push for a healthcare system that serves people—not bureaucracy, not fraudsters, and not political talking points.
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