Five and a quarter billion dollars is a lot of money and could be the amount of money lost to fraud in the Medicare Program. Who is doing anything about it? Who or what is making these criminals or quasi-criminals pay for their theft or who is setting up programs to prevent it. Let’s highlight three programs and one organization’s efforts in this regard.
Department of Justice Enforcement Efforts
This organization of the Federal Government is right properly angry with these criminals and is doing something about it. The department seems to be focused on the return of the money and putting criminals in jail. The following are some snippets of their efforts and excludes the additional efforts of the states.
• During Fiscal Year (FY) 2009, the Federal Government won or negotiated approximately $1.63 billion in judgments and settlements, and
• For fiscal 2009 The Medicare Trust Fund received transfers of approximately $2.51 billion during this period as a result of these efforts, as well as those of preceding years, and
• In FY 2009, U.S. Attorneys’ Offices opened 1,014 new criminal health care fraud investigations involving 1,786 potential defendants, and
• Federal prosecutors had 1,621 health care fraud criminal investigations pending, involving 2,706 potential defendants, and filed criminal charges in 481 cases involving 803 defendants.
This cost of these prosecutions is quite substantial being just under a quarter of a billion dollars. More information is available at http://www.justice.gov/dag/pubdoc/hcfacreport2009.pdf. I think it is comforting that these efforts are under way.
The Private Sector
One company directing its products to fraud detection is FICO of Minneapolis, MN. Fraud is so widespread in that they have two offices in California, one in Brazil, England, Germany, Spain, and a number of Pacific Rim Countries. Their goal is to develop and invent computer programs that detect fraud before bills are paid. Their programs apparently attempt to prevent current and emerging fraud schemes in the areas of up coding, collusion, high or low billing amounts, unusual billing patterns, or unusual movement and sharing of patients between facilities. Fraud is a business. They are on the side of prevention. They apparently try to stay ahead of these inventive criminals. See more at http://www.fico.com.
Then there is The Association of Certified Fraud Examiners (ACFE) at http://www.acfe.com. This organization is located in Austin Texas and has locations in London and Japan. They have 50,000 members and ACFE provides reference materials and resources, fraud training and certifications, and a job board because one would assume there is a need for this occupation.
It seems as if there is always open hunting season on Congress. John Steele Gordon is an Economic Historian. He has written an absolutely stellar book called Hamilton’s Blessings, The Extraordinary Life and Times of our National Debt. The relationship is that the sizable increase in the national debt is due to the increase in the entitlement programs one of which is Medicare. A hog will gorge himself on corn and a criminal on money. It seems Congress has provided for the continuing spending of money via a backdoor by a permanent appropriation of money to these programs which are not reviewed each year as say the defense budget or the budget for the department of Agriculture. It appears that the Congress, both right and left, believes that the voters can’t hold them accountable for a yearly review of this portion of the budget which is increasing at an alarming rate. They may be correct. This is an abdication of their responsibility.