Medicare fraudsters rake in billions

Medicare fraud is a multibillion-dollar business preying on an ever-increasing number of retiring baby boomers who often are being charged for medical treatments and products they don’t need and for services they don’t receive.

The health care reform legislation pending in Congress — and under debate in the Senate — relies on reining in these fraudulent schemes to help finance coverage for the uninsured. But analysts in and out of government question whether those savings will ever be found.

Despite bolstered efforts by federal, state and local law enforcement authorities to crack down on fraudsters, abuse continues to grow.

Assistant Attorney General Lanny A. Breuer, who heads the Justice Department’s criminal division, told the Senate Judiciary Committee’s subcommittee on crime and drugs in May that 3 percent to 10 percent of the $800 billion spent on Medicare and Medicaid each year “is lost to waste, fraud and abuse.”

“As government spending on health care for the elderly, disabled and poor increases, so does the opportunity for fraud. Criminals are devising more sophisticated ways of stealing billions of dollars from federally administered health care programs, and they are stealing it faster now than ever before,” he told The Washington Times.

Mr. Breuer said the theft of taxpayer money from these programs drives up health care costs and ultimately damages the economy.

“We have to fight health care fraud in any way we can,” he said. “We are working hard to meet these challenges.”

Much of the dishonesty is in regions deemed “high risk for Medicare fraud,” such as Miami, Los Angeles, Detroit and Houston. But Inspector General Daniel R. Levinson of the Department of Health and Human Services said his office finds fraud “everywhere it looks.”

Even dead people are receiving benefits.

Malcolm Sparrow, a faculty member at Harvard University’s Kennedy School of Government and a specialist on health care fraud, told the same Senate panel that heard Mr. Breuer’s testimony that the inspector general’s office at HHS reported in 2000 that $20.6 million in claims had been made for medical services performed after the Medicare recipient had died.

In 2006, he said, the office said states made $27.3 million in Medicaid payments for services after the patient was dead.

Mr. Sparrow said the Senate Permanent Subcommittee on Investigations reported in July 2008 that “between $60 million to $92 million was paid for medical services or equipment that had been ordered or prescribed by dead doctors.”

He told The Times in an interview that the government has to increase its spending on fighting health care fraud by as much as 10 times to reduce fraud in a meaningful way.

But he warned: “There is not a lot of political will for massive beefing-up.”

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