Re: Only the far far left can still ignore the administrative failures.
posted at 5/3/2013 4:33 PM EDT
Yes the govt does awesome!!
When President Obama pushed through his health care bill, he cut more than $500 billion (over 10 years) in future Medicare spending in order to claim the bill was “paid for.” A better option would have been to aggressively target Medicare and Medicaid fraud, which could have provided the same amount of savings, and possibly more.
Barely a day goes by without a major news story highlighting some new Medicare or Medicaid scam that has bilked the government — that is, taxpayers — out of millions of dollars.
Though most of the reports involve only a few people and scamming under $10 million, that’s chump change when compared to some of the bigger busts.
For example, federal authorities announced on May 2 they had arrested 107 health care providers, including doctors and nurses, in several cities and charged them with cheating Medicare out of $452 million.
To put this in perspective, the collapse of the solar company Solyndra, which had taken $535 million in taxpayer dollars from the Obama administration, has been a recurring topic in the media and public debates. The Medicare fraud arrest mentioned above was a news story for only a day or two.
Or there was the 2010 story in which federal officials charged 94 people with $251 million in phony claims.
The problem isn’t new. Federal officials set up the Medicare Fraud Strike Force in 2007, which visited at random nearly 1,600 businesses in Miami, ground zero for Medicare fraud, that had billed Medicare for durable medical equipment. Officials found that nearly a third of the businesses, 481, didn’t even exist, yet they had billed Medicare for $237 million over the previous year, according to National Public Radio.
Indeed, scamming Medicare and Medicaid is so lucrative that the Russian and Nigerian mobs have gotten involved. And one of the New York crime families has moved to Florida because defrauding Medicare is both more lucrative and less dangerous than some of the traditional organized crime activities.
And Medicaid is just as bad, or worse. New York City has been a huge problem for Medicaid with one former official suggesting that 40 percent of NYC’s Medicaid payments are “questionable. ” The New York Times, in a multi-story expose several years ago, reported that a Brooklyn dentist had filed 991 claims in one day.
And while every state struggles with Medicaid fraud, the Office of Inspector General says the five topping the list are California, Texas, New York, Ohio and Kentucky. The good news is that states recovered $1.7 billion in fraudulent payments in 2011. The bad news is the government had to spend $208 million to do it.
Federal authorities boast of recovering $4.1 billion in 2011 from fraudulent activity, but again spent millions of dollars to recover it.
How much Medicare and Medicaid fraud is there? No one knows for sure. In 2010 the Government Accountability Office (GAO) released a report claiming to have identified $48 billion in what it termed as “improper payments.” That’s nearly 10 percent of the $500 billion in outlays for that year. However, others, including U.S. Attorney General Eric Holder, suggest that there is an estimated $60 to $90 billion in fraud in Medicare and a similar amount for Medicaid. Big money!
Ironically, ObamaCare cutting $500 billion, as I have pointed out elsewhere, was an accounting sham. However, there is so much Medicare and Medicaid fraud that Democrats could have covered much of the cost of ObamaCare without the accounting tricks, had they really gone after it.
To be fair, the Obama administration is trying. ObamaCare allows the Department of Health and Human Services (HHS) to step away from its “pay and chase” model — where Medicare and Medicaid routinely paid every bill that comes in and only goes after someone if it’s blatantly obvious that something was wrong … like 991 dental procedures in one day.
HHS is beginning to embrace what private sector health insurers have done for years: pre-claims adjudication. As HHS Secretary Kathleen Sebelius stated, “Now, we’re analyzing patterns and trends and claims data, instead of just going claim by claim,” according to MSNBC news. That is certainly a step in the right direction, but it doesn’t go far enough, nor fast enough.
There are no good numbers on how much money private sector health insurers lose in fraud, but working with a well-known health care actuary a few years ago, we estimated that private insurers lose perhaps 1 to 1.5 percent in fraud. Medicare and Medicaid may be closer to 10 to 15 percent. And one of the primary differences is that the private sector insurers embrace software and other new technologies that help them find discrepancies and fraud in health care claims.
It’s true that politicians routinely claim they are going to get the fraud and waste out of government programs, and almost never do. The difference here is that HHS’s pay and chase model has been an open invitation to fraud — and criminals gladly accepted it.
Catching the scammers after the fact is too late; most of the money is already gone. The government needs to process claims in a way that identifies questionable and improper claims before they are paid. If the Obama administration really wants to lower health care spending, Medicare and Medicaid fraud is a good place to start.