Saturday, January 12, 2013

Why We Can't Have Nice Things

(Editorial cartoon by Jim Morin / Miami Herald (January 10, 2013) and featured at McClatchy DC.  Click on image to enlarge and then hustle back.)

Although Jim Morin's cartoon is directed toward Medicare, I think it applies to Medicaid as well, especially since the two programs are often lumped together during budget talks.  That said, I am particularly interested in the buttons labeled "Fraud" and "Lax Oversight."  I've mentioned Medicare fraud in several prior posts, usually via a Granny Bird Award.  The same principles apply to this one.

Medicaid is usually administered, at least partially, by the states, and a recent article in the Minnesota Star Tribune details one such case of fraud.

The operator of a home health care agency in northeast Minneapolis stands accused of filing bogus Medicaid billings totaling more than $400,000, his second legal round of legal trouble while a businessman in the city.

Abshir M. Ahmed, 40, of Minneapolis, was charged Tuesday in federal court in Minneapolis with health care fraud. Ahmed was charged via information, indicating that he intends to plead guilty.

According to prosecutors, from January 2008 through June 2011, Ahmed submitted false claims through Lucky Home Health Care Inc. for services by personal care assistants that were not carried out.  [Emphasis added]

That's pretty much the same modus operandi used by Medicare fraudsters.  The scams go undetected for a long time both because some of the regulations are loosely written and because the claims are just accepted and paid unless someone notices something peculiar.  Especially in state cases, this can happen often because the regulatory agency just doesn't have enough funding to review each submitted claim carefully.

The Obama administration has done a pretty good job in discovering and shutting down fraud in the Medicare arena.  It would be nice if the feds and states would take the same stance on Medicaid, perhaps with regulation-tightening and with funded investigations.  Half a million dollars may not sound like much, but it mounts up quickly across time and across the country.  It's time to do some pushing here.

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