Nipping the improper Medicare pay in the bud

James M. Berklan
James M. Berklan

Does the Centers for Medicare & Medicaid Services need its own deputy sheriff to set its house in order? Some seem to think so.

It seems like every few months there's a federal report trumpeting how many millions or billions of dollars have been recovered after incorrect government payouts were made. 

Some reports show the amount recovered has substantially shrunk. But does that mean there is less going out improperly in the first place, or that there is simply less rigorous investigating going on?

No matter, according to a group of lawmakers. Their point is that the reclamation process should not have to take place.

Their motto, using Barney Fife-speak, would have to be “Nip it in the bud!”

Rather than lauding the efforts of auditors and prosecutors to reclaim misspent taxpayer dollars, Sen. Orrin Hatch (R-UT) and pals are criticizing the administration's approach. The “pay-and-chase” method, as they call it, is out of date, they say.

While Democrats and administration officials might accuse Hatch et. al. of being buzz kills, the latter could have a very good point. File it under the “ounce of prevention is better than a pound of cure” maxim.

Some say it comes down to preventive vs. reactive maintenance. Prevent the mess rather than clean it up later. We know there WILL be messes if nothing is done, especially when it comes to federal programs and the abuse they suffer. It's a bit like the old Fram Oil Filter commercial: “You can pay me now or pay me later.”

One thing everybody can agree on is that the 12.1% error rate that Medicare's fee-for-service programs experienced last year was far too high.

Let there be no mystery then why the phrase “value-based purchasing” is so prevalent in healthcare reimbursement discussions today.

Sen. Hatch and fellow letter writers asked for information about the fraud filters the administration uses, along with the process that the Centers for Medicare & Medicaid Services uses to gauge the effectiveness of fraud-prevention efforts. It will be interesting to see what comes of it, if anything.

One theory is that providers could face more stringent checks-and-balances and tougher payment criteria in the future.

That's not the bullet they're hoping for, I'm sure.