According the latest federal government report obtained by the Associated Press, the Centers for Medicare and Medicaid (CMS) has ignored the warnings and very obvious red flags with the scamming of Medicare and Medicaid. As an example, internal inspectors and watchdogs consistently provided overwhelming evidence that organized crime was deeply entrenched in the fraud.
Additionally, the federal report revealed there was more than 47 billion tax dollars lost by claims from questionable and/or unnecessary medical health care treatments. This same report estimated the cost of suspicious or improper Medicare payments to be in the range of 440 billion dollars over the span of the last 20 years.
So why were the warnings and blatant evidence ignored? U.S. Senator Charles Grassley’s office has repeatedly sent letters to the CMS and according to Grassley, got no response. A 2008 investigation revealed that organized crime was costing taxpayers more than one million dollars for every clinic or lab used as a “front” to bilk Medicare.
“There’s no good answer for why the bureaucracy turned a blind eye, and it’s a breach of the public trust,” said Grassley, an Iowa Republican and ranking member of the Senate Finance Committee.
Last year, the Health and Human Services (HHS) Department’s Office of Inspector General also warned CMS about the flourishing organized crime component and also received no action. In some cases where action was taken, it was at a snail’s pace. Consequently, the scammers had plenty of time to move their clinic or lab to another location with an all new business identification.
The Health and Human Services Department oversees CMS. HHS Secretary Kathleen Sebelius stated the CMS responds to fraud warnings, but there has not been sufficient funding or an efficient program in place to make a dent in exponentially growing problem.
According to the Obama administration, the goal is to cut the fraud dramatically and utilize the savings to help fund the proposed national health care program.
So, the obvious question: If the federal government has done such a pathetic job in controlling Medicare and Medicaid fraud, why would we expect otherwise with their controlling and managing a national health care system of so much greater responsibility and scope? At this point, I’m not very optimistic.
Let’s look at some examples. One area that Medicare scammers have profited from involves medical equipment and supplies. The report uncovered a case in which owners Kate and Oliver Nkuku and their Houston company named KO Medical, “billed Medicare almost one million dollars for power wheelchairs and other items they claimed had been lost, damaged or destroyed during hurricanes. The couple allegedly paid another man $400 for each Medicare patient he recruited for the scam. Medicare paid the couple $5,000 for each wheelchair, and the indictment said not one of the orders was legitimate.”
Also listed as part of the report was Medicaid paying for approximately 18 billion dollars that were categorized as “improper payments.” This included payments for highly inflated injections and unnecessary drug screening tests, treatments and lab work. Also cited were kickbacks to medical health care providers.
So what can we do as individual taxpayers? We can all do our part - every dollar counts and adds up. Both Medicare/Medicaid beneficiaries and family members should be vigilant. Review statements for any incorrect or suspicious charges. If any found, discuss and question the charges with the health care provider or insurer. If you suspect fraud, report it to the insurer or Medicare at 1-800-Medicare. Also, contact your local legislators.
As to changes in the current status quo, the Centers for Medicare and Medicaid Services is expected to overhaul its payment information system. The Health and Human Services Department has stated it has increased the number of agents and prosecutors who investigate fraud.
Finally, let’s hope both our federal and state governments establish more efficient ways of reducing fraud and waste so we can maintain a health care system for those who have paid into the program and deserve care when needed. Consider how the current system could be improved with the billions of dollars going into the pockets of thieves!
Mary Garza Cummings is a free-lance writer. The Town Crier does not warrant the information as valid. It is the responsibility of the reader to ensure validity of the information. If you have questions or comments, email firstname.lastname@example.org