- - Tuesday, April 5, 2016


Blocking private auditors enables improper payments

An invitation to Medicare fraud

C.S. Lewis once said, “Integrity is doing the right thing, even when no one is watching.” This is a powerful exposition that’s long inspired and, sometimes, nagged at me. But go a bit deeper, and you must admit that one of the best arguments for integrity is that even if no one is watching right now, that doesn’t mean no one will ever find out.

What would you call doing the right thing, even when you knew no one would ever check to see what you did? An act of moral heroism? Yet it’s the baffling current practice of the federal government to almost never check when it comes to monitoring Medicare payments.

This past fall, the Obama administration quietly changed the rules for hospitals that bill billions of dollars annually to the federal government so that only one-half of 1 percent of their payments are subject to audit — a laughably absurd restriction that renders the process toothless.

Make no mistake: This was not a reward for good behavior. According to the Government Accountability Office (GAO), the amount the government wastes on fraud and improper payments is up 356 percent from 2003, a large majority of which comes from the exact program that was just shielded from even the most basic accounting standards.

Last summer, the Medicare Trustees projected the Medicare trust fund would go bankrupt in 2030. About six months later, after the change in auditing rules, the Congressional Budget Office moved the estimate up four years, to 2026.

Keep in mind that Medicare spending has been exploding in recent years, routinely outstripping previous estimates. When was the last time the government surprised you by spending less than it was supposed to? I fully expect the next president will have to deal with this.

It is totally outrageous that the program singularly responsible for the majority of improper payments across the entire federal government was just given a special deal to avoid accountability.

The amount wasted is staggering: $90 billion in 2015 for improper Medicare and Medicaid payments, according to the GAO, up 15 percent from just the year before. (At that rate of increase, the amount will reach $200 billion after five years).

The $90 billion is nearly twice the gross domestic product of Costa Rica. It is the combined after-tax income of 1.5 million Americans. In 100-dollar bills, $90 billion weighs 1.8 million pounds, four times the weight of a Blue whale, the heaviest animal to have ever existed on earth.

It’s one-and-a-half times bigger than the dreaded “sequestration” cuts. It’s about the amount the government spends annually on its four largest contractors — Lockheed Martin, Boeing, Raytheon and General Dynamics — combined. It’s enough to build seven aircraft carriers from scratch, 119 Hoover dams, or 114 Empire State buildings. You could even build the hilariously bloated California high-speed rail project ($67 billion) and still have enough money left over to take all 319 million Americans out to dinner at Morton’s steakhouse ($15.3 billion would buy a 12 oz. filet mignon for every person).

The government has wasted more than a half-million dollars since the time you started reading this article. This is serious money we’re talking about. Meanwhile, Congress and President Obama are standing by, aiding and abetting the fraud, while there is a perfectly effective solution that stands ready to solve it.

The Recovery Audit Contractors program allows credentialed private auditors to review the books of companies that are billing all these improper claims. When they identify fraud, they are paid a small percentage of any funds the government eventually recoups.

Launched nationwide in 2010, the program helped recover a shocking $10 billion during its brief existence, despite only allowing the contractors to review 2 percent of payments.

But just as soon as it started racking up successes, the beneficiaries of the illegal payments hit back with vengeance, utilizing an army of lobbyists to severely restrict the contractors.

Obama administration bureaucrats put a tourniquet on the documents these companies can review, cutting them down to 0.5 percent of all payments. They also walled off many categories of payments from any review. The bill is coming soon. When Medicare runs out of money in a few years, just remember that special interests made sure the government was aiding and abetting the fraud that helped the program go broke.

• Dean Chambers is a conservative columnist and freelance writer.

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