Tuesday, March 12, 2013

WFAA’s dental fraud investigations recognized and lauded by Forbes

Ending White House Tours Instead Of Ending Medicare And Medicaid Fraud -

Merrill Matthews, Contributor
March 7, 2013


“White House Tours will be canceled effective Saturday, March 9, 2013 until further notice,” according to a White House email.  Meanwhile, billions of dollars pour out of Medicare and Medicaid because of waste and fraud.  Indeed, eliminating Medicare and Medicaid fraud, rather than White House tours, would offset the sequester cuts for the next decade.

two idiotsI don’t know how much money President Obama thinks it saves by canceling White House tours, though I’ll bet it’s a lot less than one of his golfing trips on Air Force One, which costs about $180,000 an hour to fly.

But we do have several estimates of how much Medicare and Medicaid fraud cost.  Typical estimates, which have been echoed by the Obama administration, put the figure in the $60 billion a year range for each program.

A study by the Rand Corporation pegged Medicare and Medicaid fraud at about $98 billion in 2011, roughly equal to the future annual budget cuts (actually, reductions in the rate of growth) imposed by the sequester.

The Government Accountability Office’s (GAO) most recent estimate for Medicare, released in February, claimed there was a total of $44 billion in improper payments in 2012.  That figure is a little lower than the $48 billion for 2010.

Not all of the GAO calculation is fraud.  It includes overpayments and underpayments, unnecessary services, coding errors and other problems.  And there is fraud that isn’t detected by the GAO report.  But you get the idea; it’s a big problem and getting bigger as criminals and the mob get more brazen in their efforts.  For example:

  • Last May federal authorities charged 107 doctors, nurses and social workers with a nationwide Medicare fraud scheme that allegedly bilked the system of $452 million.
  • In June of last year, prosecutors charged a man with fleecing Medicare of $31 million and funneling it to a bank in Havana.  So perhaps Cuban dictator Fidel Castro’s medical bills are being paid by Medicare.
  • Last September a Dallas-area man, Cyprian Akamnonu, entered a plea agreement in which he would provide information about Dr. Jacques Roy and his associates’ efforts to drain $375 million from Medicare in a nursing home scam.
  • Last year Medicare officials estimated nearly 80 percent of power wheelchair claims didn’t meet Medicare guidelines, leading to $492 million in improper payments.
  • Federal officials reported last January that Medicare improperly spent more than $120 million between 2009 and 2011 providing medical services to inmates and illegal immigrants.  (Remember that when the White House claims ObamaCare won’t be paying for illegal immigrants.)

And then there is Medicaid.  Recent investigations by WFAA, a Dallas ABC affiliate, discovered that Texas spent $1.4 billion on pediatric orthodontics (i.e., braces for kids’ teeth).  Turns out that was more than all other states combined.  A closer look found some dental practices, whose owners lived in multimillion dollar mansions, coaxed low-income kids into getting the braces even though most did not have any serious oral health problems.  The state is investigating, but it wasn’t federal or state officials who detected the scam; it was journalists at a TV station.

To be fair, the Centers for Medicare and Medicaid Services (CMS) is trying to catch the fraud.  The question is how effective it has been.  Obama’s health care legislation set aside $77 million for anti-fraud purposes and gave CMS the authority, for the first time, to engage in pre-claims adjudication and predictive analytics — essentially examining claims for problems and anomalies before they are paid.

And CMS has spent $3.6 million creating a glitzy new anti-fraud center.  But Senators Tom Coburn and Orrin Hatch have raised a number of questions about the effectiveness of the effort.  “After our offices saw a live demonstration of the FPS [the anti-fraud center], we have concluded there is a significant disconnect between the rhetorical claims made by the administration and the system’s actual current operational status,” according to a statement from the senators.

[ Health and Human Services or Health and Hedge Fund Services]

Indeed, Bloomberg reported last July that the government has spent at least $102 million in auditing fees on Medicaid since 2008 and was able to identify less that — wait for it — $20 million in overpayments.  And next year we add 16 million more people to the Medicaid rolls.

[ Just think, Dr. Paul Casamassimo will have 16 million more people to call degenerates!  He measures people by the social program they use, right? ]

So while there are some anti-fraud success stories, no one thinks we are even close to shutting down the massive fraud efforts in Medicare and Medicaid that would save billions of taxpayer dollars.

Meanwhile Obama and the White House have doubled down on petty efforts to convince the public the government is running on a shoestring — efforts that include emails telling federal agencies to maximize the pain felt by the public.  And that apparently includes canceling White House tours.  Not tours in the future that wouldn’t affect people who had already made plans; but imminent tours, disappointing lots of people.

I wish I could say that such antics were beneath the White House, but they aren’t; not this White House.  It has demonstrated that it will go to any measure to convince Americans that taxes are too low and spending cuts are too high.

Merrill Matthews is a resident scholar at the Institute for Policy Innovation in Dallas, Texas.  Follow at http://twitter.com/MerrillMatthews