Finally, Someone In The Federal Government Did Something Right

It is certainly not often that I say this but finally someone in the Federal government did something worthwhile and right, as outlined in an article from the Associated Press on July 16, 2010. Let it not be said that I do not recognize it when the political class does something right for a change and consistent with my book, "Love My Country, Loathe My government." In this case, they were executing Step 5 from the book that insists that more enforcement resources be expended to stop the massive amount of fraud and waste that government programs incur every year. By the government's own estimate, this fraud could be as high as $90 billion a year or about $770 for every U.S. household just from the Medicare program.

The article described a massive law enforcement round up of 94 people who were involved in defrauding the Medicare program, and the U.S. taxpayer, of Medicare funds. Details of the bust include the following:

• People were arrested in various cities including Miami, New York City, Detroit, Houston and Baton Rouge.
• The 94 people arrested were charged with pilfering $250 million of Medicare funds.
• 33 of the people were arrest in Miami and charged with stealing $140 million but that the real amount of total fraud in the Miami area is closer to $3 billion.
• Those arrested are accused of bilking Medicare for unnecessary equipment, physical therapy, and other treatments that patients never received.
• In one such scam, $72 million were paid out for bogus charges to just one clinic in Brooklyn. Wiretaps show that one man at the clinic did nothing but hand out money in the back of the clinic all day long.
• People let the scammers use their Medicare numbers and cards in exchange for $50 to $100 per visit.
• In another Brooklyn case, more than 3,700 claims were submitted on behalf of just one woman, who also was arrested (she is 82 years old). Just her false billings alone resulted in payments of $141,161.
• The types of people involved in Medicare fraud include doctors, clinic owners, patients, patient recruiters, and organized crime.
• Two people in Miami are accused of bilking Medicare out of $119 million for costly HIV drugs that patients never received. They then turned around and spent the money fraudulent funds on hotels, helicopters, boats, and a water park.

Kudos to all involved who made this happen. It is a great start. Hopefully, it is only a start because:

• while the Miami busts identified $114 million in fraud, this is only 3.8% of the total fraud thought to be going on in Miami.
• how come the Feds did not identify the woman in Brooklyn with over 3,700 claims much sooner, say around the 2,000 claim mark? Are the Federal data systems or human watchdogs so oblivious that they had to wait until there were 3,700 claims for the same person before they moved in to stop the fraud?
• the article says that for the first time, investigators can actually stop payments to a claimant if they think fraud is afoot. Up until recently, claims were paid upfront without any questions asked and follow up was either non-existent or ineffective. Why did we wait several decades to put this simple fix into the payment process? It could not have been a surprise that this was the main cause of the fraud, why did the political class wait so long for a common sense fix?
• while $251 million is good, how much will actually be recovered and how much has already been spent and no longer exists?
• and yes, $251 million is good but it represents only .3% to .4% of the probable annual Medicare fraud nationwide.

Yes, this is a great first step and it is a step that I have advocated since the beginning, making it one of the premier steps of the fifty steps laid out in the book. My bigger concern is that the political class is about to make this government insurance pot of money much bigger, as a result of Obama care, attracting much more fraud if we are not careful.

The analogy I would use would be like buying a new heating system for your house. Prior to buying that new heater, a reasonable person would first check the basics: better insulation in the attic, weather strip the windows, weather strip the doors, etc. Once you fix the basics, you can now buy a less expensive heating system since you plugged all of the holes in the house first. That is what should have been done with Obama care. The basics should have been done first, i.e. put the data systems in place and the enforcement resources and processes in place first to clean up the fraud. Once you had the fraud under control, you can come out with a less expensive health care reform bill since the holes would have been plugged, saving the taxpayer substantial money. Unless this first step quickly morphs into a much bigger and wide ranging anti-fraud process, we are putting that heater into that house without the proper insulation and lord knows how much heat will escape along with our tax dollars.


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http://www.flipcongress2010.com/