Fraud-fighting efforts not much to brag about

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John O'Connor
John O'Connor
In what has become a frequent event, the Inspector General at the Department of Health and Human Services has just issued yet another report that crows about heroic fraud-fighting efforts.

The latest installment notes the office helped recoup $5.2 billion in fraud-related funds during fiscal 2012.

By most standards, $5.2 billion is hardly chump change. And it's great that this funding will presumably find a better home. But compared to the rampant theft and corruption going in healthcare these days, it's hard to believe the totals aren't considerably higher.

In November, McKnight's covered three fraud-related developments in our sector alone. Most notably, the Inspector General issued a report that basically charged nursing home operators with over billing Medicare to the tune of $1.5 billion each year.

Another IG investigation found Medicaid personal care services are ripe for abuse. The IG said care attendants and beneficiaries are combining to defraud with increasing frequency.

We also reported that a Chicago-psychiatrist was accused of submitting $190,000 in false claims to Medicare and Medicaid and receiving kickbacks for prescribing antipsychotics.

And this is just what's being uncovered in our own back yard, this month.

By some estimates, the amount of healthcare fraud committed in this nation each year easily tops $100 billion. Stopping 5% or so of that criminal activity is hardly the sort of thing that should trigger glowing reports about a job well done.

Well then, how should the government be more vigilant against the bad actors? For starters, regulators might want to actually heed some of the advice they have already been given. In House testimony earlier this week, the director of the Government Accountability Office criticized the Centers for Medicare & Medicaid Services for not following previous recommendations. These measures include integrating predictive-analytics tools for fraud detection into existing IT systems, removing Social Security numbers from Medicare cards, and requiring providers in high-risk areas to post surety bonds.

For years, we've been listening to various government officials tell operators to get better. Maybe some of these folks need to start taking their own advice.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.


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