Saturday, September 25

Little progress on Medicare fraud

George LeMieux in the Wall Street Journal referring to a $77 million fraud detection system started in 2011:

In its first eight months, the new system yielded a miserable $7,591 in suspended payments. While that number might increase over time, such a negative return is consistent with the track record of the Medicare and Medicaid administrators — who, according to a GAO study released in June, spent $102 million over four years to find $20 million in overpayments.

Second, while the personnel responsible for administering the fraud-prevention system have repeatedly promised in open hearings and speeches to make the results of their efforts public, they have proven unable or unwilling to answer basic questions about their work. The underlying legislation requires administrators to modernize their antifraud system and outlines basic reporting requirements, such as program implementation and actual and projected savings. The administrators haven’t complied with those requirements so far, inviting strong criticism from Republican and Democratic members of Congress.

Third, despite claims by White House Chief of Staff Jack Lew that this administration is the “most transparent ever,” political staff overseeing the Medicare program are currently holding back a report on the fraud-prevention system that, under the 2010 law, was required to be made public by Oct. 1. The reporting requirement was designed to offer seniors a full and transparent account of the administration’s efforts in implementing the fraud-prevention system.

The fact that the report is being withheld suggests either that the ­administration doesn’t have a good story to tell, or that its bureaucrats are hiding their own ineptitude. The latter is likelier because in a report made public on Nov. 14, the GAO confirmed that while the Medicare and Medicaid administrators have implemented a new fraud-prevention system, they haven’t yet allowed it to stop suspicious payments.

More at Lots of Talk, Little Action on Medicare Fraud: Some government antifraud and antiabuse efforts are actually losing more money.

There is no doubt that fraud and abuse in Medicare and Medicaid cost well over $100 billion per year. Advocates of these systems point to their low administrative costs compared to private, for-profit health care insurance companies. But these companies care about fraud and abuse. Government programs don’t care that much.