Medicare fraud and abuse not a new story, where have the bureaucrats been the last fifteen years?

I have been asking the question “Which health insurer is easiest to deal with?” the answer in every case has been Medicare. That quick answer is often followed with “they don’t pay much but they pay everything.”

Here is an excerpt from a CBO report:

Weak controls for detecting questionable billing practices. All Medicare bills are screened for consistency and completeness as part of the initial processing of claims. Even very high volumes of services to individual patients or by individual providers do not necessarily trigger further review before payment. Currently, less than 5 percent of Medicare claims are reviewed.

Inadequate checks on the legitimacy of those billing the program. Medicare lacks stringent requirements for issuing billing numbers to certain providers. In some cases, phantom companies with only a post office box number have qualified to bill the Medicare program. Also, surveys of providers are too infrequent to ensure their continued compliance with Medicare’s conditions of participation.

Little chance of being prosecuted or penalized. The weak controls on billing mentioned above make it unlikely that inappropriate claims will be detected, but when they are detected recovery is uncertain. Penalties are often light, large penalties are difficult to collect, and providers often continue to bill Medicare.

The above is from a 1995 report.

During the health care debate of 2009 and 2010, much was made of the savings to be generated by cracking down on Medicare fraud and abuse.  What we should be asking is what were the bureaucrats and politicians doing for the last fifteen years.

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