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Wanna Save 54 Billion Dollars? Crime on the Health Care Front

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While politicians are busy declaring success in health care reform I just gotta ask -- What about the Medicare and Medicaid fraud that cost us a collective 54 billion dollars last year? When will lawmakers address that problem?

Crooks flock to where the money is. So no one should be surprised that as the amount of money being spent on health care in this country rises, so have the number of fraud cases connected to that industry.

There was the scam in which Medicaid and Medicare patients were billed, monthly, for wheelchairs they never got or didn't need. There was the phony program to provide liquid food, like Ensure, to undernourished elderly -- except it turns out most people didn't get the delivery and many of them were dead. Last summer there was a fraud plot afoot that provided Medicare patients with "arthritis kits." In reality, the kits were nothing more than a heating pad and joint braces and many patients reported they never even received them. No matter, the criminals billed the government up to 4 thousand dollars for each kit.

You and I paid that fraudulent tab and many more just like it.

How much is this kind of criminal activity costing us? The Associated Press recently described it this way: "Improper payments -- in the wrong amounts, to the wrong person or for the wrong reason -- totaled an estimated $54 billion in 2009. They range from simple errors such as duplicate billing to elaborate schemes operated by fraudsters peddling everything from wheelchairs to hospice care."

This makes me cringe. We lost 54 billion dollars last year to criminal schemes?! There must be a special place in hell for those who would prey upon the sick and elderly, especially at a time when our health care system -- our whole economy -- is in such crisis.

It's not as though local, state and federal agents aren't out there diligently trying to right the criminal's wrongs. Every year well coordinated task force stings are staged in cities across the country - Miami, Houston, Detroit, Los Angeles to name just a few -- but still the losses mount.

President Obama now wants to deploy an army of so-called high-tech "bounty hunter auditors" to root out waste, fraud and abuse within the government's health insurance programs. Sounds like a great idea to me -- if it works.

We're told the auditor's weapons will be sophisticated new computer programs to scan Medicare and Medicaid billing records nationwide to check for patterns of bogus claims. And like the early bounty hunters of the old West these modern day crime fighters will get to keep a percentage of what they recoup for taxpayers. It seems like a win-win idea. Pilot programs in California, New York and Texas over the last three years re-captured 900 million dollars that would have otherwise gone into the crook's pockets.

The White House says these private auditors could recover least $2 billion of our tax dollars over the next three years. That's a significant savings, to be sure, but it also seems like a drop in our 54 billion dollar bucket of losses.

So how did we get to the place where we allowed annual losses of 54 billion dollars? In part it happened because prosecuting these types of fraud cases can be slippery.

First, the government has to hinge its prosecution on how "appropriate" the medical care was. As we all know expert witnesses are for hire to testify to just about any position needed. Sometimes it's just easier for prosecutors to plea down the charge and hope the criminal gets scared straight.

Second, there are graduating levels of laws that can be applied. Some of them call for harsh punishment for each transgression, that is, for each patient who's been taken advantage of in the commission of the fraud. But many other anti-fraud Medicaid and Medicare laws call for fines as low as 10 thousand dollars and sentences of up to just five years in jail. That's not much of a deterrent for a seasoned fraudster who rakes in hundreds of thousands or even millions of dollars and then quickly pulls up stakes to move on to the next new scam in the next location. The odds are in the crooks favor.

I'm thinking it's time for the legal penalties to catch up with the severity and breadth of the crimes currently being committed. At the very least it's time for prosecutors to agree to fewer plea bargains and for judges to dole out the harshest possible sentences for those who prey upon our weakest citizens and our good intentions to help the sick.

If the nation's security is dependent on a healthy economy then maybe we should start to look at Medicaid and Medicare fraud as a threat to national security -- a sort of treasonous act. Treason carries a penalty of life in prison.

Okay, I'll just settle for a mandatory 20 years, with no possibility of early release, to get these creeps off the street.

Diane Dimond may be reached at her web site: www.DianeDimond.com

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