Nipping improper Medicare payments in the bud

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James M. Berklan
James M. Berklan

Does the Centers for Medicare & Medicaid Services need its own Barney Fife 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, including Medicare and Medicaid. One striking item we ran recently was indeed about BILLIONS that wrongly went out but was later reclaimed.

I guess there's some consolation that the amount recovered that year had substantially shrunk — if you're looking at it from the point of view that it means there is less going out improperly. On the other hand, some will say the lower number is because there is less rigorous investigating going on.

None of that matters, according to a group of lawmakers. Their point, as colleague Emily Mongan eloquently noted Monday, is that the reclamation process should not have to take place, or at least take place a lot less frequently.

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 The “pay-and-chase” method, as they call it, is out of date, they say.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 might 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 maintenance vs. reactive maintenance. Prevent the mess, rather than clean it up after it becomes apparent later. And you know it will become apparent 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 that noted, “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 have 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.

Follow James M. Berklan @JimBerklan.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.