How Fraudsters Are Bilking the Government Out of Billions of Dollars

Summary

Odd Lots Podcast Summary Episode: How Fraudsters Are Bilking the Government Out of Billions of Dollars Release Date: November 18, 2024

Bloomberg's Odd Lots delves deep into the pervasive issue of government fraud, particularly within the healthcare sector. Hosts Joe Weisenthal and Tracy Alloway engage in a comprehensive discussion with guest Jetson Leader Luis, an assistant professor at Boston University's Questrom School of Business and a faculty research fellow at the National Bureau of Economic Research (NBER). Luis's expertise lies in analyzing mechanisms through which companies defraud government programs, wasting potentially billions of dollars annually.

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1. Introduction to Government Fraud in Healthcare

[01:17] Joe Weisenthal opens the episode by posing a provocative question: "How to defraud the government?" This sets the stage for an in-depth exploration of systemic fraud within government-funded programs.

2. Guest Introduction and Research Focus

[05:11] Jetson Leader Luis introduces himself, outlining his academic background and research focus:

"I'm interested in questions about fraud in government spending... particularly in the healthcare system where there are impactful policies trying to eliminate fraud."

Luis highlights the historical under-analysis of government spending fraud, emphasizing the need to understand what measures effectively curb fraudulent activities.

3. Ambulance Fraud in Medicare

[07:01] The discussion zeroes in on a classic example of healthcare fraud: ambulance services under Medicare.

"Ambulance services are highly reimbursed and low overhead... easy for people to start and bill the government." — Luis

Key Points:

• Non-Emergency Ambulance Fraud: Fraudsters established ambulance companies not to provide genuine medical services but to exploit Medicare's reimbursement policies, leading to over $7 billion in fraudulent claims over a decade.
• Government Response: Initial crackdowns involved incarcerations, but this only led to a revolving door where new fraudulent entities quickly emerged.
• Solution Implemented: Introduction of prior authorization requiring physician approval for ambulance rides resulted in a 67% drop in fraudulent spending without any negative health impacts on patients.

4. Durable Medical Equipment (DME) Fraud

[16:07] Luis elaborates on DME fraud, describing it as the "wild west" of healthcare fraud:

"There are three types of health care fraud: upcoding, medical necessity fraud, and substandard care."

Types of DME Fraud:

• Upcoding: Billing for higher-end equipment, e.g., charging for a superlux wheelchair while providing a basic model.
• Medical Necessity Fraud: Claiming equipment is necessary when it isn't.
• Substandard Care: Providing inferior quality equipment to patients who genuinely need it.

Impact: DME fraud persists due to low oversight and the ease of initiating fraudulent claims, despite existing regulations like the 20% copay requirement, which is often circumvented by fraudulent firms.

5. Mechanisms of Fraud Detection and Prevention

[23:15] Luis discusses the False Claims Act as a pivotal tool in combating fraud:

"Every nurse, every billing agent, every doctor has the information to identify fraud... the whistleblower gets a share of the money they bring back to the government."

Key Strategies:

• Whistleblower Programs: Encourage insiders to report fraud by offering financial incentives.
• Data Analysis: Leveraging comprehensive Medicare claims data to identify irregular spending patterns indicative of fraud.
• Prior Authorization Processes: Requiring approvals for services to ensure legitimacy.

6. Fraud Beyond Healthcare: Unemployment Insurance During COVID

[25:55] Luis expands the conversation to fraud in other government programs, notably unemployment insurance during the COVID-19 pandemic.

"There was widespread identity theft fraud where individuals purchased Social Security numbers to claim unemployment benefits."

Impact: The massive expansion of unemployment benefits created new avenues for fraud, with potentially billions of dollars lost through fraudulent claims.

7. Propagation of Fraudulent Practices

[28:45] The dissemination of fraud techniques often occurs through social and corporate learning:

"Consultancies and centralized management often spread fraud strategies across companies and regions."

Examples:

• Corporate Learning: Large chains adopt fraudulent practices from consultants, leading to widespread embezzlement.
• Online Communities: Platforms like Telegram and Facebook host groups where individuals share techniques for exploiting government programs.

8. Data-Driven Detection and Enforcement Challenges

[31:17] Luis articulates the critical role of data in identifying fraud:

"Run-ups in spending, massive year-over-year increases that don't align with legitimate growth."

Challenges:

• Enforcement Capacity: Limited staffing and inadequate compensation for data analysts hinder the government's ability to effectively monitor and act upon fraudulent activities.
• Information Asymmetry: The government lacks detailed insights into certain sectors, making detection difficult.

9. Positive Externalities and Policy Implications

[36:17] Luis introduces a nuanced perspective with the hospice care example:

"Policies aimed at limiting fraud can inadvertently restrict beneficial services if the criteria are too rigid."

Case Study: Hospice Care Fraud

• Issue: For-profit hospices exploited eligibility criteria, enrolling patients who did not meet the necessary end-of-life prognosis to receive higher reimbursements.
• Research Findings: Contrary to expectations, restrictions to prevent fraud in hospice care did not negatively impact patient outcomes and actually saved significant government funds without compromising care quality.
• Implication: Policy designs must balance fraud prevention with maintaining access to essential services.

10. Recommendations for Enhancing Government Efficiency

[39:16] In response to hypothetical leadership by figures like Elon Musk or Vivek Ramaswamy, Luis outlines strategic measures to combat fraud:

"Double the number of fraud-focused staff at the Department of Justice... invest in data analysis and machine learning."

Key Recommendations:

• Increase Anti-Fraud Staffing: Hiring more data analysts and legal professionals to enhance detection and enforcement.
• Invest in Technology: Utilizing machine learning and advanced data analytics to proactively identify fraudulent patterns.
• Rigorous Policy Evaluation: Continuously assessing the effectiveness of anti-fraud measures to ensure they deliver desired outcomes without unintended consequences.

11. The Scope and Potential Savings from Combating Fraud

[42:03] Luis estimates the magnitude of the problem:

"Healthcare fraud in the United States is around $100 billion a year."

Potential Savings: With effective anti-fraud strategies, substantial portions of this money could be recovered, allowing for better allocation of government resources across various public programs.

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Conclusion

The episode of Odd Lots underscores the intricate and evolving nature of government fraud, particularly within healthcare. Through expert insights from Jetson Leader Luis, listeners gain a comprehensive understanding of how fraudulent activities are perpetrated, detected, and mitigated. The discussion highlights the critical need for enhanced data capabilities, increased enforcement staffing, and nuanced policy designs to effectively combat fraud while preserving essential services. The overarching message is clear: with strategic investments and evidence-based approaches, the government can significantly reduce fraudulent expenditures, thereby safeguarding public funds and ensuring resources are utilized efficiently.

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Notable Quotes:

• Jetson Leader Luis [07:12]: "Ambulance services are highly reimbursed and low overhead... easy for people to start and bill the government."
• Jetson Leader Luis [16:31]: "Durable medical equipment has been the wild west of the healthcare system for 20 years with billions of dollars of fraud."
• Jetson Leader Luis [23:21]: "The whistleblower gets a share of the money they bring back to the government."
• Jetson Leader Luis [31:17]: "Run-ups in spending, massive year-over-year increases that don't align with legitimate growth."
• Jetson Leader Luis [39:16]: "Double the number of fraud-focused staff at the Department of Justice... invest in data analysis and machine learning."
• Jetson Leader Luis [42:03]: "Healthcare fraud in the United States is around $100 billion a year."

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Additional Resources: Listeners interested in exploring more about Jetson Leader Luis's research can visit his website at jetsonleaderluis.com or access his published papers for deeper insights into government fraud mechanisms and prevention strategies.

Transcript

[Jetson Leader Luis]

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[Max Chavkin]

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[Jetson Leader Luis]

We just lived through a truly wild presidential race, pitting a Democrat who wasn't on the ballot until June and a Republican who was convicted on 34 felony counts just before receiving his party's nomination for president. But the wildest thing might have been this guy. If you already believe in the Constitution, you're just signing something you already believe and you can win a million dollars. That's awesome. I'm Max Chavkin and this is Citizen Elon, a three part series from Elon.

[Joe Weisenthal]

Inc. Where we investigate Elon Musk's unprecedented.

[Jetson Leader Luis]

Support for Donald Trump. Follow Elon, Inc. On Apple Podcasts or wherever you like to listen.

[Tracy Alloway]

Bloomberg Audio Studios Podcasts Radio News.

[Joe Weisenthal]

Hello and welcome to another episode of the Odd Lots Podcast. I'm Joe Weisenthal.

[Tracy Alloway]

And I'm Tracy Alloway.

[Joe Weisenthal]

Tracy, what do you think about doge.

[Tracy Alloway]

The coin or the new Department of Government Efficiency?

[Joe Weisenthal]

The latter.

[Tracy Alloway]

Here's what I will say. Part of me hates that government efficiency is being politicized in this way. Because if you think that government services are a desirable thing to have, then you should definitely be against waste and inefficiency and fraud in that market. Because at a minimum, if you're wasting money, you could be using that money to do even more. And then obviously, if you think that government is just bad in general, then I imagine that you also think that the government wasting money is also bad.

[Joe Weisenthal]

So there's no constituency. There probably shouldn't be an ideological constituency or political constituency for waste, right?

[Tracy Alloway]

Yeah, exactly. I feel like we should all agree on this. But also I hate the way it's kind of unrolling, let's put it that way.

[Joe Weisenthal]

I would say I broadly agree waste is bad. Whether the existing makeup of this sort of quasi blue ribbon commission to get rid of waste, whatever that means, is actually going to do it. Look, I'll be open minded, but I like the premise of cracking down on waste. I will just say that you know what the other thing is. So first of all, part of the issue here is that waste is probably difficult to define. Fraud in some cases is probably difficult to define. There will probably be political fights over certain types of spending that it's like, you call this waste. I call this a good allocation of whatever. I imagine many of the political fights around this will sort of revolve around some of these questions. There's a lot there. But I'm glad we generally agree that.

[Tracy Alloway]

Fraud is bad, fraud is bad, waste is bad. But I think you're absolutely right that the definitions are going to be crucial. Right. And this is where I worry about the politicization because you can just come in and say like, oh, well, I don't like this, so I'm going to call this a waste and go on from there. But I think we should talk about it because, you know, this has come up in a number of episodes, specifically on the PPP post pandemic. And so it's clearly something that is on people's minds.

[Joe Weisenthal]

Totally. Right now we are recording this Thursday, November 14th. We are in a moment where resources in the economy are constrained.

[Jetson Leader Luis]

Right.

[Joe Weisenthal]

The unemployment rate is low. Inflation continues to be by some measures above the Fed's goal. It is not crazy from like a macro standpoint to think we need to make things more efficient and better to have a better use of our real resources right now.

[Tracy Alloway]

And one, this is your other middle aged man thing that decided to become like a real resource constraint guy, right?

[Joe Weisenthal]

Yeah. I'm like, oh, we gotta, we gotta crack down.

[Tracy Alloway]

You have to make tough decisions.

[Joe Weisenthal]

You gotta make tough decisions. We're taking the candy away from the kids. I'm gonna be one of those guys.

[Tracy Alloway]

Here's a tough decision. If you're gonna talk to someone about government waste, would you talk to Elon or Vivek? There's two.

[Joe Weisenthal]

Well, Elon would get more downloads if we had him on the podcast. So I would talk to Elon, but we actually have a better guest. I think we have the perfect guest to talk about government waste fraud, where we might be able to move the dial in a substantive way on this kind of stuff. We're going to be speaking with Jetson leader Luis. He is an assistant professor at the Questrom School of Business at Boston University. He's also a faculty research fellow at the nber and this is what he studies, particularly areas around fraud and how companies defraud the government, wasting millions, probably billions of dollars. So, Jetson, thank you so much for coming on Odd Lots.

[Jetson Leader Luis]

Thanks so much for having me.

[Joe Weisenthal]

Why don't you describe your research? I kind of described it, but why don't you describe what you do and your background?

[Jetson Leader Luis]

Yeah, that's great. So I'm an assistant professor. I study economics and in particular I'm interested in questions about fraud in government spending. I received my PhD from MIT Economics in 2020 and I've written a number of papers trying to explore the mechanisms the government can and does use to cut out fraud in public expenditure.

[Tracy Alloway]

Was there a particular moment or reason that drew you to this particular field?

[Jetson Leader Luis]

I think fraud in government spending has historically been under analyzed and in particular in the healthcare system where I've done a lot of work. There are really big and impactful policies that are being used to try to eliminate fraud. But historically we didn't really understand what worked and what didn't work and why it worked. And so I think, you know, there was a big opportunity in the research there and I've always been interested in questions of bad behavior. I have a paper that I started early in my career on fraud in the World bank that we just got accepted at the Journal World Development. And so overall I'm really interested in this question about where is the money going and how can we fix that to make sure that the federal funds are being used for people who need them?

[Joe Weisenthal]

I definitely want to talk a little bit about fixing the problem and identifying the problem and so forth, but actually I really want to start on how to defraud the government because no, for real, because sometimes we'll see headlines. It's like so and so arrested for insurance fraud of some sort. And that's bad. But I also have this weird thing that happens in my head where I'm like, I wouldn't even know how to defraud.

[Tracy Alloway]

Tell us what's the most accessible way to defraud the government?

[Joe Weisenthal]

So give us an example or when we talk about, okay, fraud in the medical system, what are people doing? What is a classical form of defrauding the government in the world of healthcare?

[Jetson Leader Luis]

So in the world of healthcare there are some really obvious frauds that have persisted for years and that I think we're finally maybe starting to wrap our hands around. And one that comes to mind immediately, immediately is the ambulance market.

[Joe Weisenthal]

Ok, say more.

[Jetson Leader Luis]

So this was actually described to me when I first heard it by a colleague friend who works for the federal government as the perfect health care fraud. And so ambulance services are paid for by Medicare. Medicare is the old age health insurance program for Americans. We spend more than $800 billion a year on this program. We spend another $700 billion a year on Medicaid. So we're talking about $1.5 trillion of outlays to these programs. It's very hard for the Government to ensure that every dollar that's going out is legitimate. Right. It's just, it's a volume problem.

[Joe Weisenthal]

Yeah.

[Jetson Leader Luis]

Ambulance services are highly reimbursed and low overhead. If you want to start an ambulance company, you need to buy an ambulance that's like 30 grand used online. You can actually go and Google it yourself. You can go buy an ambulance and then you need a couple of employees. It's actually a super low overhead business, which means it's easy for people to start. Starting around, we think 2003, the market for ambulance services, and in particular repetitive non emergency ambulance services started getting saturated by intentional fraudulent actors.

[Tracy Alloway]

Wait, what's a non emergency ambulance?

[Jetson Leader Luis]

A non emergency ambulance is a patient who needs to go to a service because they are sick enough that they can't ride in a taxi or take the train. And the only safe way for them to get to a service is in an ambulance. And in particular, this really blew up in the dialysis industry. Dialysis patients, there are about a half a million of them. We actually spend, I think, you know, this 1% of the federal budget on the dialysis program. One incredible, not 1% of Medicare, 1% of the federal budget is the dialysis program. We do not in general pay for ambulance rides or taxi rides for these people to go to and from the visits. They are responsible for getting themselves to the clinic every day, three times a week, generally for a few hours. And that's in perpetuity. It's very challenging to get a kidney and therefore to get off of dialysis. So we had this system, and this is sort of the canonical Medicare fraud. We build in a little thing for the few people who need it, and that turns into a loophole through which bad actors drive a truck. So we built in this provision which is if the only safe way that you can get to the dialysis clinic is in an ambulance, Medicare will pay for an ambulance. And they pay for it at a competitive rate for the ambulance companies at say $250 for a one way ride. Now that's not that much money for a real ambulance, but it's a heck of a lot of money for a taxi. And what happened is thousands of firms around the country opened with the express intention not of giving people serious medical care, but of becoming an expensive ambulance taxi and billed the government. We have 100% data from the dialysis system. We can see all of these payments. More than $7 billion for non emergency ambulance transportation over the following 10 years. $7.7 billion. And a lot of it was Fraud. And the government cracked down. The government really tried to crack down. And in particular, they used a number of tools. The first one is they started throwing people in prison. This is what you say you see in the headlines. Yeah, but it's so easy to start an ambulance company that we'd see these stories where, you know, someone gets busted and their family member goes and opens a company next door the next day. And this persisted for years with thousands of companies and billions of dollars of spending just down the drain.

[Tracy Alloway]

I imagine some of the difficulty is also deciding who genuinely needs an ambulance ride and who doesn't. Right. So this is something that I never quite understand about US healthcare in general. The first 10 years of my adulthood were in the UK and there's a National Health Service there. And if the doctor told you you needed something, you know, you got that something. Maybe it would take a while, but eventually you would get it. Whereas in the US you seem to have all these decision makers in the process, and yet we're talking about medical care, which you would think would need to be dictated by, like, highly trained medical doctors.

[Jetson Leader Luis]

This is super interesting that that's your intuition, because that's exactly how they fixed it. So the way that Medicare closed this loophole was by requiring what's called prior authorization. Now, if instead of going to an ambulance company and saying, you know, please give me this ride, or the even worse, the ambulance company coming to the patient and saying, do you want a taxi ride? Which is actually what was happening, instead, they required that a physician sign off and say, look, this patient is actually sick. They're bedridden. There's no other way that they can get to dialysis this week. And if you didn't have the doctor's note, Medicare didn't pay. And we estimate that around the timing of them implementing this prior authorization requirement, which they rolled out in different states at different times, this is like what economists love in our research, an actual test. A difference in difference. Exactly. When they rolled this out in different places in different times, we see a 67% drop in spending the next month. Persistent. And not only that, we can then trace the patients and say, were these patients harmed? Did they actually miss their dialysis visits and end up in the hospital? And we find no evidence at all of negative patient health effects. And so we actually saved billions of dollars by putting in something that was so basic, which is this. The doctor signed.

[Tracy Alloway]

Why didn't they do it before?

[Jetson Leader Luis]

The structure of Medicare is largely disaggregated, where individuals are able to go to different services, as long as they qualify for them. And some of those are doctor's visits, hospitals, medical equipment, pharmaceuticals. We pay for a lot of things. And there is a real worry that requiring too much paperwork can burden the system. And we don't want to turn the Medicare system into an even more heavily administrative burden system. So there are different qualification rules, but largely what happens is the qualification rules are not always enforced upfront. We do a lot of requiring people to follow the rules. Maybe we do some audits, maybe we chase after them with criminal lawsuits afterwards. But largely there are circumstances where nefarious actors, It's a relatively high trust system. Nefarious actors will find these loopholes and drive a truck through them. And I can talk about a million examples of that.

[Joe Weisenthal]

Well, let's talk about. So, okay, it sounds like the ambulance fraud is taken care of, more or less.

[Jetson Leader Luis]

So the ambulance fraud is less than it used to be. And that's the dialysis ambulance fraud.

[Joe Weisenthal]

Oh yeah.

[Jetson Leader Luis]

This paper was just accepted at the Journal of Political Economy. So we're super happy. Shout out to my colleague, congratulations, who did a great job there. The ambulance market itself has other frauds. Right. We're talking about one type, which is this repetitive dialysis fraud. There are still lots of unnecessary ambulance rides, ghost ambulance rides, where patients don't even get in the ambulance and bills are sent. One question is what can the government do? And part of it is I think that there needs to be a better focus on using data to detect and stop the fraud.

[Tracy Alloway]

Yeah, talk to us about the data because I imagine like you're talking about government spending and programs, plus in some instances the medical industry, there must be interesting data available to you.

[Jetson Leader Luis]

So I have fantastic access to Data. I use 100% sample Medicare claims data from 1999 through 2019 for all inpatient and outpatient services, durable medical equipments. I can see 20% of physician office visits and part D pharmaceuticals. So it's a ridiculous volume. And you know, I'm very equipped with data. I teach data analysis and I have, you know, PhD students and other professors who work with me. And even for us, it's a big problem. How do we actually wrap our hands around this? Yeah, the government has not historically invested very well in its data analysis for anti fraud. Part of the reason is that the organizations that are responsible for this, which are the Department of Justice and the Office of the Inspector General, those career lawyers are fantastic. I cannot say enough positive things about my colleagues at the Department of Justice and the Office of the Inspector General. But There are too few of them. We do not pay them very well. And they are not data analysts, they are lawyers.

[Joe Weisenthal]

Okay, so you mentioned there's still some ambulance. The dialysis specifically sounds like that was mostly taken care of. There's other ambulance fraud out there. You mentioned that some people, that there's billing ghost ambulances or people never even ride the ambulance. What's hot right now? What's the new ambulance fraud?

[Jetson Leader Luis]

So what's amazing here is that it seems like it's a constantly evolving marketplace. Right? We have to think fraud is a technology where people figure out a loophole and then they tell their friends and these things spread and eventually the government catches up. And so we're playing cat and mouse every year right now. I think it's wound care.

[Joe Weisenthal]

Okay, say more about wound care.

[Jetson Leader Luis]

There's been a rise in these expensive treatments for patients with non healing wounds. So if you're diabetic, you're likely to have neuropathy. And one of the things that comes with diabetic neuropathy is that you often have wounds, particularly on their feet, where the patient doesn't heal. There are some modern technology, skin substitute things you can graft onto these wounds that seem like they pay pretty well and potentially even work. And then a few doctors have just started spending millions of dollars on that. But that's a flash in the pan. Historically, we see fraud really rife in the durable medical equipment industry. There's been fraud in basically everything that health care touches. Another thing right now that's really popular, we're seeing a lot of fraud in vascular care that is helping patients who have collapsed veins be able to receive intravenous treatment. But again, it's just like.

[Joe Weisenthal]

Well, just to drill into specifics, let's just. Durable medical equipment fraud.

[Jetson Leader Luis]

Yes.

[Joe Weisenthal]

I want to get into it. What am I doing?

[Jetson Leader Luis]

So you want to get into durable medical equipment fraud. Well, you're in luck because durable medical equipment has been the wild west of the healthcare system for 20 years with billions of dollars of fraud. I have to admit I'm writing a paper on it right now that I'm excited. I know a lot about it. So you remember the scooter store they used to advertise on late night tv? Are you an old person?

[Joe Weisenthal]

Oh, yeah, yeah.

[Tracy Alloway]

Do you have a Medicare number?

[Jetson Leader Luis]

Would you like a free wheelchair?

[Joe Weisenthal]

Yeah.

[Jetson Leader Luis]

So there's been some excellent kind of investigative journalism on this. So durable medical equipment. I want people to think walkers, wheelchairs, oxygen pumps, hospital beds in their home, things that people need that are supposed to Be permanent. You know CPAP machines.

[Joe Weisenthal]

Yeah.

[Jetson Leader Luis]

And these are largely given by suppliers that are sometimes big national firms and sometimes small mom and pop shops. I want you to think about Florida. This is sort of a Florida story. If you're interested in selling someone a, you know, a fraudulent walker or pump or something like that. It's actually.

[Joe Weisenthal]

What does it mean, a fraudulent walker?

[Tracy Alloway]

One that doesn't work, one that you don't need.

[Jetson Leader Luis]

I guess this is super interesting. Right? So what do we mean when we say fraud? Healthcare fraud has different types. Right. And I can break it. There are three types of health care fraud. There's upcoding. That's where I sell you a little push wheelchair. But I go bill the government for a superlux automatic wheelchair. We call that upcoding. There's medical necessity fraud. That's where we say that a patient needs something and they don't. And then there's substandard care. That's where we have a patient who actually does need something and we give them junk. And all of them happen in all forms of medicine, but in particular in durable medical equipment. I think it's a lot of medical necessity fraud. I think we have patients who are getting a knock on the door high. Do you want this fancy new device free to you? Now what's really interesting is we're actually supposed to collect a 20% copay for the durable medical equipment products. But the fraud, and that's designed by Medicare to make sure that patients aren't getting stuff that they don't need.

[Joe Weisenthal]

So they have to have some skin in the game.

[Jetson Leader Luis]

They're supposed to. But if you're a fraudulent firm, you just don't collect it. You're very happy to have the government's 80% and the patient wouldn't take it if they had to pay.

[Tracy Alloway]

Yeah. What's been the. I'm trying to think how to frame this, but I guess what's been the cultural or like incentive approach in government to stamping out fraud? If I am a government official and I design up a poor social service program of some sort that has a bunch of loopholes that ends up costing lots of money, do I get in trouble or do I get rewarded if I manage to tweak the program so that it doesn't have a lot of.

[Jetson Leader Luis]

Fraud in it, the government generally underinvests and misprices its anti fraud investments. By which I mean when we consider how we are measuring what the government is doing to stop fraud, you're talking about these career civil servants and how we Reward them. Historically, the focus has been on how much are you getting back. And I've made this point in a bunch of research and I recently released a white paper through the center for Medicare and Medicare Medicaid Services saying how much money you get back is irrelevant. That is the wrong number. That is really the number that everyone in government is focused on. When you say anti fraud recovery, we caught this many people, we put this many people in jail and we got, you know, $1 billion back this year. And the point that I've made is the money you're getting back is just a small share of the effect of your anti fraud efforts. What you should really care about is your deterrence effect. And I've shown in research deterrence effects are in many cases like 10 times larger than these recovery dollars. So if you go to the Department of Justice and you talk to their healthcare fraud people, they write a report to Congress every year. It's called the Health Care Fraud and Abuse Report. And they put a number there for return on investment. And Congress asks them, tell us how much money did you spend and how what was your return on investment? And they say the number is four. And ok, first of all, forex return on investment already, very good. That immediately means that we should spend more resources there. But I think that's actually the wrong number. I think the number is 40 because the 4 is only counting money that they're getting written to them in terms of checks back.

[Joe Weisenthal]

Right?

[Jetson Leader Luis]

But if you count deterrence, and you have to count deterrence, the value of these anti fraud efforts is huge. So do we reward people in terms of the value they bring? This is Tracy's question. In some sense, yes. Right? It's look, there's a press release. They trot out the Attorney General, maybe the civil servant gets at a minimum.

[Tracy Alloway]

I could go to my boss and be like, I saved us $20 million.

[Jetson Leader Luis]

But largely, no, we don't pay these people well. We don't retain them well. If you look at Your average assistant U.S. attorney, they go to the government for a few years, do fantastic work and then realize that private industry pays three times as much and they leave.

[Max Chavkin]

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[Marin Sums]

Not everybody likes talking about money. Some people find it awkward. Sometimes they even find it a little embarrassing. I do not. I like talking about money, whether it's the boardroom, the newsroom, the trading floor. I've spent the last 30 years talking about money, writing about money and talking about it and writing about it a little bit more. I'm Marin Sums at Webb and every week senior reporter John Steppeck and I answer your questions about personal finance and we discuss the best strategies for making the most of your money. Listen in for the kind of insights and explanations everyone can use to help them make better saving and investment choices for themselves and their families. My question is whether you think maxing out my company pension match is enough for when it comes to saving for.

[Jetson Leader Luis]

My pension, should I attempt to pay my child's university fees and living costs? My partner and I have excess savings. So should we overpay on our mortgage or should we put the money into stock?

[Marin Sums]

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[Joe Weisenthal]

When we were talking about the original dialysis ambulance fraud, it sounded like there was a very elegant solution. Just get a doctor sign off. When you look at some of these other emerging frauds and you mentioned wound care for example, or you mentioned someone gets a really nice scooter that they didn't really need or something like that, and you mentioned that the requirement of putting up 20% co pay is not that effective because the seller is just like, you know what, we'll take the hit and only take the 80% is no big deal. How much of the challenge is on the data and identification side, which we should talk a little bit more versus the mechanism which you use to crack down on it.

[Jetson Leader Luis]

So I'm actually really in favor of this program. We use the big whistleblower program called the False Claims Act.

[Joe Weisenthal]

Okay.

[Jetson Leader Luis]

And I've written extensively. Do you guys know how this works?

[Tracy Alloway]

No.

[Joe Weisenthal]

No.

[Jetson Leader Luis]

It's the weirdest, coolest thing. I mean, for an economist. Okay, so there is a private market for anti fraud in the US if you know about a company or person that is defrauding any public program not specific to healthcare, you can hire your own attorney and there are firms that specialize in this. You can sue that person in federal civil court and the whistleblower gets a share of the money they bring back to the government. And this is a super effective program because it means that every nurse, every billing agent, every doctor in a hospital, if that organization does this is what.

[Joe Weisenthal]

We'Re gonna get into. Tracy. I'm not gonna do fraud because even though I wanna know how it works, but I do want to make a lot of money.

[Tracy Alloway]

I'm gonna become a fraud bounty hunter.

[Joe Weisenthal]

Yeah, say more about bounty hunting. Keep talking about that.

[Jetson Leader Luis]

It's bounty hunting. But bounty hunting is great because of two reasons. The first is there's this private information component. Rather than waiting for some analyst in Washington to figure out today's fraud, just make a huge reward available for the individuals who know about it. Because there's lots of information. Right. If from an economist perspective, the problem here is the problem we have in a lot of healthcare. It's information asymmetry. The doctors and the hospitals and the nursing homes know so much more about the patient than the insurance company. And here the insurance company is the government. And so rather than trying to make just top down solutions, and there are some top down solutions, don't get me wrong, it's really important that we also allow the individuals who have the information, the valuable information, to be rewarded for that. So the whistleblower program, private information. There's also the private cause of action. The idea that every person can become literally the legal term sometimes used as private Attorney General. Right. You can go and hire a lawyer and sue. And that lawsuit is on behalf of the United States of America. And this has been an extremely effective program historically.

[Joe Weisenthal]

Say more about that.

[Jetson Leader Luis]

Yeah. So I ran a Freedom of Information act request on the Department of Justice for data on every whistleblower lawsuit from 1987 through about 2017 when I first filed this. There are thousands of these cases. They've brought in billions of dollars for the government. 55% of them are in healthcare. But they're also used all over the government. We see cases related to the Transportation Department, the Department of Education, the Department of Defense. And the idea is the same. Instead of trying to have the government figure out how to run anti fraud, anti fraud can pay for itself. There are lots of people who would love to earn a million dollars being a whistleblower. And these whistleblowers get paid pretty well.

[Tracy Alloway]

Since you mentioned transportation and education just then, can you talk about some examples of fraud outside of the medical sector?

[Jetson Leader Luis]

Absolutely. So I have a recent paper about the unemployment insurance market during COVID so I'd be happy to talk about that.

[Tracy Alloway]

Oh, that's great.

[Jetson Leader Luis]

So during COVID we had the biggest expansion of unemployment insurance in history. I think you guys know about this. You've talked a little bit about PPP and there's some great research there on fraud. PPP was for companies. Unemployment insurance was for individuals who lost their job. And we expanded it to also include gig economy workers through a program called pua. You guys probably know about this.

[Joe Weisenthal]

So this is starting to feel like history to me. It's so crazy because this is like yesterday, but also it's like, it feels so long ago. Yeah, but, yeah, keep going.

[Jetson Leader Luis]

The time distortion is real. So unemployment insurance rose heavily during the pandemic, and with it came a lot of fraud. Now, why is there fraud in the unemployment insurance sector? Well, the government's cutting checks, and the government's cutting checks really fast. So you might remember at the beginning of the pandemic, there was this immediate recession, and there was fear of the big macroeconomic consequences of everybody being out of a job, or many people, I should say, being out of a job. And so the government really loosened and expanded its use of unemployment insurance. But whenever the government says, hey, we're going to write $800 billion in checks, people get creative about ways to bilk the government. And in particular, this type of fraud was really identity theft. It is super easy, super easy to go on the dark web and buy a Social Security number. And so that's what a lot of criminals and organized criminal groups did during the pandemic. There was a widespread fraud where individuals would go purchase identities, apply en masse to state unemployment insurance programs, collect the money, take it out of the system, and then we think in many cases, it was either offshored or rerouted to criminal organizations. So this was so incredibly widespread. Actually, my wife got a prepaid debit card in the mail from the unemployment agency, and she didn't lose her job. I've talked to just dozens of people across the country and in all sorts of sectors who said, yeah, this actually happened to me.

[Tracy Alloway]

Wait, this leads to something that I want to ask as well, which is, how is fraud propagated? Because this kind of gets to Joe's question earlier. How do people actually do this? How do I learn to do fraud? Is it like I just look it up on the Internet, or is it like someone I'm associated with tells me?

[Jetson Leader Luis]

So different frauds have different mechanisms by which people learn them, but in general, there is a social learning component to this. Absolutely. So with some of the institutional frauds that we've been talking about, a hospital that decides that they're going to suddenly charge a lot of money through some loophole, often there are business decisions being made by executives. Sometimes there are consultants involved and big national Chains often are the ones that spread these because they have kind of centralized management. The hospital administrators from different hospitals look at this. I'm thinking, for example, of the tenant hospitals which paid $900 million back to the government for a small little loophole that was supposed to be for an outlier payments program. And they just drove a truck through that loophole. They ended up stealing.

[Joe Weisenthal]

What was that about?

[Jetson Leader Luis]

So if you go inpatient in a hospital, the hospital gets paid a fixed amount under Medicare through what's called a prospective payment system. They don't pay per cost. They just say, you know, you have pneumonia, we're going to pay this much. The government was worried when they set this program up that some very expensive patients wouldn't get treatment, because if the hospital knows that and they know that, they're going to lose money on you. So they made this asterisk. A lot of these things are asterisks to have an outlier payment system where if a patient is super expensive, then they pay extra. And the tenant hospitals figured out how to make every patient look super expensive by manipulating some of their balance sheets. And they ended up spending $900 million to, excuse me, they ended up to settle claims. So that Tenet never admitted fault, I should say. But the government received $900 million back from Tenet because, you know, these allegations were, I think, true that Tenet had done this. And I estimate actually that the government lost billions of dollars to that. Okay, so, but I want to go back to this question. So how did that one happen? Well, there was a consultancy in New Jersey that was going around telling people, hey, do you know about this outlier payment system? And that's how we think that that fraud spread, and it spread all over the country. So there's some of this corporate learning from other companies, and there's also a lot of social learning. So in the case of unemployment insurance fraud or PPP fraud, you can go and you can find telegram groups and Facebook groups of people that are like, here's how you apply for a PPP loan. There's a great new paper by John Griffin at the University of Texas on these Facebook groups. And like, they're called like fraud kings. Like they know what they were, maybe PPP loan kings or something like that. It's like really obvious what they're doing and everyone knows. And so in the case of healthcare fraud, in the case of non healthcare fraud, often it's you're surrounded by people who know how to do this, or you meet them through digital platforms and then People learn. And so a lot of the fraud we see propagates through communities. In the case of the ambulance market, we saw that there were certain Eastern European groups that were responsible for this in different parts of the country and often from the same, from original areas. And so generally the understanding, at least from the government is that there must have been some social learning going on there. It's very hard to prove, of course.

[Joe Weisenthal]

Right. Someone figures it out and then tell family members. That's right. That makes sense. Let's talk about detection via data and more. And you talked about how you have access to all of this data and so forth. Obviously you can describe fraud qualitatively by saying this is how an ambulance company cheats the government, etc. What do the fingerprints of fraud look like when you look at it on the macro scale? What do you, what pops up in the data? That would at least be a yellow flag and say, this is something we need to look at more.

[Jetson Leader Luis]

So there are huge run ups in spending in every type of fraud I've ever seen in every type of fraud. I mean, the whole point is if you're not making money, it's not a good fraud. Right? And so if you just make a plot of spending against, you know, time, you can often just see these really big exponential growth. Now some of those are legitimate because if there's a new great medical technology and people start using it, that also looks like a technological adoption curve, right? Of a kind of big upward ramp. But when it's fraud, first of all, it looks like massive year over year increases. The second is that it'll often be way too much to the point where it's obvious that nobody's getting this. For example, sometimes you'll see a doctor who's just billing for too many home care visits, but the home care visits are 60 minutes and the doctor is billing for 5,000 of them a year. It's like, well, that's 5,000 hours. There aren't 5,000 work hours in the year. The government should just be able to detect that. You should just not pay those. So where the failure is is not in how hard it is to detect in data that's not that hard to detect in data. It's on the incentives for the enforcers to look at that data and use it appropriately. And that's where we get back to this limited enforcement capacity.

[Tracy Alloway]

How do you measure benefits on the other side? Because that seems again like a potential avenue where there could be some disagreement.

[Jetson Leader Luis]

So I think it's super important that we preserve access to the public programs. And my research is not focused at all on how do we take things away from people. And in particular, I always try to measure very hard whether there are health effects associated with this. So in the case of the ambulances, we're able to show pretty definitively that there are no negative health effects associated with cutting this. And this is something I do in all my papers. You really have to ask the question, were people losing care that they needed? And so super, super great question. In the context of some of these very obvious frauds, sometimes people aren't even getting the service. So if the government's paying for something and nobody ever got it, taking it away is costless. So that's the best efficient thing that we could do is just stop paying for things that aren't even happening. Right? Let's not even talk about waste. Let's just talk about these outright frauds. And so how do you measure it? I mean, if you look at very large scale claims data as I do, and the government can, you can see, okay, we cut out this provider, let's look at their patients, did they go to the hospital more? That's an empirical question. Right. And so there's no reason that it just has to be a guess. Right? This is something that we should be measuring as part of our data analysis associated with antifrog.

[Max Chavkin]

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[Marin Sums]

Not everybody likes talking about money. Some people find it awkward. Sometimes they even find it a little embarrassing. I do not. I like talking about money. Whether it's the boardroom, the newsroom, the trading floor. I've spent the last 30 years talking about money, writing about money and talking about it and writing about it a little bit more. I'm Marin Sums at Webb and every week senior reporter John Stepak and I answer your questions about personal finance and we discuss the best strategies for making the most of your money. Listen in for the kind of insights and explanations everyone can use to help them make better saving and investment choices for themselves and their families. My question is whether you think maxing out my company pension match is enough for when it comes to saving for.

[Jetson Leader Luis]

My pension, should I attempt to pay my child's university fees and living costs My partner and I have excess savings. So should we overpay on our mortgage or should we put the money in.

[Marin Sums]

To stocks from Bloomberg Podcasts? Tune into Marin Talks Money. Follow Marin Talks Money on Apple Podcasts, Spotify or wherever you listen.

[Joe Weisenthal]

So it's very obvious why, whether we're talking about the government or private insurance, that it's just rules on top of rules on top of rules and asterisks and so forth. Because this is very complicated stuff. Rules also create problems and compliance by the rules can, you know, strict adherence to the rules can also have negative effects. I have to imagine, for example, that there are say many people in the US currently on some sort of GLP1 drug, but maybe technically they don't have the thing. But you know, there seem to be a lot of benefits from weight loss and so forth. Have you found examples in your research in which there is some sort of positive externality from deviation from the rules?

[Jetson Leader Luis]

Absolutely. Absolutely. Thanks for cueing this up. I have a great story. So let's talk about the hospice industry. Hospice care is an end of life benefit for patients who have a prognosis of six months or less. So if you're dying and a physician certifies that you're dying within six months, you qualify for hospice. What is hospice? You give up the curative care and you stop taking all of these meds with the horrible side effects and you stop going to the hospital as often and you can die peacefully at home with pain medication. And I think that this is a great program. I think it's really important. We spend $20 billion a year on the federal hospice program and more than 50% of Medicare patients who die every year will have had a hospice claim. Ok, this is important. This is the way that we're treating people. At the end of life. It's really hard to know who's dying within six months. That is not a trivial estimate. And historically there was subjectivity in this. So over the 20 year period 1999 through 2019, there was a quadrupling of for profit hospices. And many of them increasingly took Alzheimer's and dementia patients. Why? Because they stay for a long time on these hospice programs. And the hospice programs are paid about $200 a day. And the federal government cried fraud. And we saw 163 federal whistleblower lawsuits against for profit hospice companies, more than $300 million in settlements saying this is fraud. You shouldn't have taken the patience. You should have known that they weren't dying fast enough, that they did not qualify for hospice. So I wrote a paper with John Gruber at MIT, as well as one of our PhD students and David Howard at Emory, some really top notch economists. And we looked at this program, we said, okay, this is something people are really concerned about. And what we found really knocked our socks off. The fraud actually was not as bad as people said. In particular because did some patients go to hospice who may otherwise not have because they were not dying fast enough? Sure. But it's still a heck of a lot cheaper to go to hospice for six months than it is to go to the hospital and the nursing home and the home care agency and the durable medical equipment and the pharmaceuticals. And we estimate that these patients saved tens of thousands of dollars. And the patients liked it. They and their families are picking hospice. This is something that they want. They don't want the hospital, so they're getting a service they want and the government is saving money. And yet we've decided that this is a fraud because there's this rule now, when you think about it from that way, six months is totally arbitrary. Why is it six months and not eight months? And so this paper, it's called Dying or Lying, it just was accepted last week at the aer. It shows pretty conclusively that the policies aimed at limiting fraud threw the baby out with the bathwater.

[Tracy Alloway]

Hmm. You know, we started this conversation mentioning doge, the new Department of Government Efficiency. I guess one obvious question to ask you would be, you know, if you are in Elon or Vivek's shoes, what would be your, you know, the first thing you would start with when it comes to rooting out fraud or I don't know if you want to get into wider types of inefficiencies, but what's the first thing you would do?

[Joe Weisenthal]

Yeah, they make you, they make you the real point person on this. How do you start?

[Jetson Leader Luis]

So first, I'm optimistic about the Department of Government Efficiency because I think that there are some clear evidence based obvious wins that we have left on the table in terms of saving government money. The first is we know that anti fraud efforts, particularly in the Medicare and Medicaid programs, have huge return on investments and we underfund them. So we could staff up those offices at the Department of Justice, at the Department of Justice districts, at the Office of the Inspector General and literally just chase down the leads that we already know about. We don't even have to go after other leads. If you look at your average civil assistant U.S. attorney, they've got 30 good cases on their Desk, and they get to pick two of them. So there. And many of these cases allege millions of dollars of fraud. And they say, I'm sorry, we have a number. We can't go under anything right now, less than 10 million. And they. And they dropped the case. So if. Even if we just doubled the number of people or at the Department of Justice who focus on fraud against the government, that would pay for itself many times over. Okay, so that's an obvious one. The second is to start getting serious about data. If we do not hire and recruit excellent analysts to look at government data from the government, we are going to miss obvious frauds. Everything I've talked about so far is not rocket science. We're talking about huge amounts of billing for patients who obviously don't need it in some of these cases. And the government pays it, and they miss it. What? They have access to that data in real time. They're writing the checks. Why are we not screening that? And the answer is not. A lot of data analysts work at the Department of Justice. And there are some. There are some that work at the Office of the Inspector General of Health and Human Services, but not that many. Why? Because they pay like $70,000 a year. And if you're a good data analyst, you don't go to work for the government for $70,000 a year. If the government wants top talent, it's got to be willing to recruit. And those are competitive positions. And so if we get serious about data, we get serious about machine learning, we get serious about investing in the attorneys who are doing the good work, and just the programs work really well. The second is rigorous evaluation. Right? We need to know when we try policies, do they work or do they not work? When we put in a prior authorization program, when we put in a new screening for people to take a selfie on their phone before we pay their unemployment insurance claim, that's actually how we fix the unemployment insurance problem. It was an identity theft problem. You just gotta take a selfie on your phone. These ideas work, but we need to evaluate them as serious policy analysts.

[Joe Weisenthal]

I just have one more question, and I don't even know whether this is capable of being ascertained in a substantive way. But when you think about the stuff that you research, and we're talking about, like, you know, big question is, can we meaningfully move the dial on fraudulent spending or maybe wasteful spending? And do we have a number that exists? Do we know how much could potentially be saved?

[Jetson Leader Luis]

So I think health care fraud alone in the United States is something like $100 billion a year. Now, that's across private and public. But we spend $1.5 trillion on Medicare and Medicaid. So the idea.

[Joe Weisenthal]

That's a big chunk.

[Jetson Leader Luis]

It's a, it's. No, it's, it's not that big of a chunk. We spent, you know, $2.3 trillion overall and so to say 50 to $100 billion a year of fraud. Yeah, I think that that number is reasonable.

[Joe Weisenthal]

Yeah.

[Jetson Leader Luis]

So can we move the needle on it? Absolutely. There are things that we know work really well. Huge treatment effects at very low cost. Now government spending, overall, we spend what, six, seven trillion dollars a year in the government.

[Joe Weisenthal]

Yeah.

[Jetson Leader Luis]

When we look at these other public programs, there are some that have obvious frauds going on. Like I mentioned the unemployment insurance system that had tens or possibly $100 billion of fraud there as well the PPP program, we spent, you know, $100 billion or at least on fraud in that program. And so not every program is rife with fraud. There are programs that are very hard to defraud. It's hard to defraud Social Security.

[Joe Weisenthal]

Why?

[Jetson Leader Luis]

Because they have your full earnings record and they pick the number and they send you a check. Very limited fraud in the Social Security system. I think that there's probably a lot of fraud in some of the infrastructure and defense. And so our framework has to be like, where does the government know the least? The government doesn't really know what's going into every element of a defense spend or every element of, you know, how is the road being built or what is the hospital doing and when you have those big information asymmetries, that's where the big fraud is. So if I think that there's $100 billion just for Medicare and Medicaid spending or maybe, you know, throw in the advantage spending and the, you know, other the federal employees health Benefits and the VA to get to the 100 billion number of that health care fraud. I think that it very easily that $100 billion also occurs yet again. And some of these other like defense. I'm sure that there's plenty.

[Joe Weisenthal]

Jensen leader Luis, amazing. Thank you so much for coming on the podcast.

[Jetson Leader Luis]

Thanks for having me.

[Joe Weisenthal]

Tracy. I am pro getting rid of fraud. No, I for real, I don't take.

[Tracy Alloway]

A lot of it seems like a low bar. Although you did ask repeatedly how you you could commit it, but I know that was for informational purposes only.

[Joe Weisenthal]

No, I'm going to actually I'm not going to get into the business of medical fraud. I'm going to get into the business of being one of those independent whistleblowers.

[Tracy Alloway]

Suing the bounty hunters.

[Joe Weisenthal]

Yeah, that sounds great, but I feel like I need to know how it works so I can identify it. But I really do think, you know, setting aside. Setting aside everything, fraud is bad.

[Tracy Alloway]

I do think, and I kind of said this in the beginning, that we can all agree that fraud and waste is bad, like, no matter where you fall on the political spectrum, because if you free up money that's not doing anything, then you could, in theory, put it to a different use and get more bang for your buck, so to speak. I think, obviously, and we touched on this, like, a lot of these decisions over what's fraudulent or especially what's wasteful, maybe not necessarily fraud, come down to specific judgments, and they can be subjective. And I think that's where a lot of the disagreement is going to be going forward. But I do think the point about using the data better, the government must have some amazing data, for sure. We kind of talked about it, especially in these specific sectors like healthcare.

[Joe Weisenthal]

Two things on the data that were really interesting. So one is just this idea that if you're a talented data scientist, go to the doj. And this has come up in some of our past episodes that we've done with a few other guests. There does seem to be this structural issue, right, of how government pays and how compelling a job in government is, et cetera. And so there does seem to be an issue with how do you staff up a big team of data scientists that are incented and have the agency and capacity to use that data or do something when they discover it. And then, you know, it was a very interesting comment, that last one about it's very hard to defraud Social Security. And so this idea of, like, where is the fraud most likely to exist? Areas in which there is some limited asymmetrical, as economists like to use information, which is, you know, the government doesn't know what happens when you are not. You and I go into a doctor, right? There's some level of information asymmetry there. It doesn't really know what kind of walker you or I are going to need in 30 or 40 years to get around, et cetera. And then furthermore, we didn't touch on it, but I do think we absolutely, as a podcast, are going to need to do more, should do way more on defense spending. There's a million angles that we have to do on that. But you could see, like, oh, we don't really know what went into the assembly of this and the cost of this program. And is this part really worth this much money? Or maybe it's a competition thing. There's a lot of fruit there for future episodes.

[Tracy Alloway]

But I do think one of the big tensions here is the sort of government generalists versus, like the experts that they're listening to. What I mean is, for instance, if you're a defense contractor and you're building, I don't know, like a submarine launch pad or whatever, like the government official isn't necessarily going to know all the nuts and bolts that need to go into that. And so, yeah, I always wonder how you sort of overcome that informational gap.

[Joe Weisenthal]

There's a lot there. Let's do more on this topic.

[Tracy Alloway]

All right. Shall we leave it there for now?

[Joe Weisenthal]

Let's leave it there.

[Tracy Alloway]

This has been another episode of the All Thoughts podcast. I'm Tracy Alloway. You can follow me Racialay.

[Joe Weisenthal]

And I'm Joe Wiesenthal. You can follow me at the Stalwart. Follow our guest Jetson leader Luis. He's etsoneconecon. Also, he has a number of papers on his website that you can just click on and go read. They're all really fascinating. Follow our producers Carmen Rodriguez, ironarman, Dashiell Bennett at dashbot and Kellbrooks at Kalebrooks. Thank you to our producer Moses Ondam. For more Odd Lots content, go to bloomberg.com odd lots where we have transcripts, a blog and a newsletter and you can chat about all of these topics in our Discord with fellow listeners. Discord GG Odd Lots and if you.

[Tracy Alloway]

Enjoy Odd Lots, if you like it when we dive deep into the data around government fraud, then please leave us a positive review on your favorite podcast platform. And remember, if you are a Bloomberg in addition to getting our new daily newsletter, you can listen to all of our episodes absolutely ad free. All you need to do is find the Bloomberg Channel on Apple podcast and follow the instructions there. Thanks for listening.

[Marin Sums]

Not everybody likes talking about money. Some people find it awkward. Sometimes they even find it a little embarrassing. I do not. I like talking about money, whether it's the boardroom, the newsroom, the trading floor. I've spent the last 30 years talking about money, writing about money and talking about it and writing about it a little bit more. I'm Marin Sums at Webb and every week senior reporter John Stepek and I answer your questions about personal finance and we discuss the best strategies for making the most of your money. Listen in for the kind of insights and explanations everyone can use to help them make better saving and investment choices for themselves and their families. My question is whether you think maxing out my company pension match is enough for when it comes to saving for.

[Jetson Leader Luis]

My pension, should I attempt to pay my child's university fees and living costs? My partner and I have excess savings, so should we overpay on our mortgage or should we put the money into stocks?

[Marin Sums]

From Bloomberg podcasts, tune into Marin Talks Money. Follow Marin Talks Money on Apple Podcasts, Spotify or wherever you listen.