Congressional bill drafters seem to be getting close to finishing a massive proposal on health care reform — a proposal that should be closely scrutinized by fraud-fighters everywhere for several reasons.
The proposal likely will include tough and innovative anti-fraud measures that will help to curb fraud committed against both public and private insurance, including property-casualty.
There’s hope that Congress will finally get serious about fraud in the Medicare and Medicaid programs. In a meeting this week on Capitol Hill, Congressional staffers admitted they’ve done a lousy job in protecting taxpayer money with these programs. While better anti-fraud efforts have been launched in recent years, the fleecing of these programs by crooked medical providers is a national disgrace.
This week a medical writer for the Las Vegas Sun, Marshall Allen, articulated this point very well:
The numbers don’t lie: The federal government does not put its money where its mouth is in terms of fighting Medicare fraud.
Everyone talks about the importance of policing Medicare fraud, but consider the following annual figures:
• Medicare billing totals more than $400 billion, and that’s mostly taxpayer money.
• Kim Brandt, who leads Medicare’s anti-fraud efforts, said some estimate the agency loses up to $80 billion to fraud, though she thinks that number sounds too high. (The truth is, no one is sure. All they know is that the more they look the more they find, Brandt said.)
• In 2008 Medicare recovered about $20.4 billion related to fraud.
• Medicare spends only about $120 million on fraud investigation.
If the problem is so large, and if every dollar spent on enforcement is multiplied exponentially in the form of recovered taxpayer money, why doesn’t Medicare spend more money to ferret out fraud?
One reason there aren’t more programs to fight fraud on the federal level is because lobbyists for medical interests have killed them. They fear anti-fraud efforts could end up costing honest providers. But killing them has ended up costing of all.
Allen cites an example of the paltry efforts in his article: Medicare spends about $20 million to support offices in three cities — Los Angeles, Miami and New York — all hotspots for fraud. Yet, among them, there are only 20 investigators.
There’s a growing realization that medical fraudsters are equal-opportunity crooks in that they ply their trade across both public and private insurance payers, and certainly between health plans and property/casualty insurance. That realty likely will set the stage for more public-private partnerships and greater levels of cooperation among the entire fraud-fighting community.
We’ll have to wait and see how health care reform and anti-fraud provisions take shape.
But one aspect is certain. If Congress is going to ask the American people to invest heavily in health care, there needs to be a sense that the money is not wasted. And they can start down that road by including comprehensive anti-fraud measures in their soon-to-be-announced package.