Sen. Bernie Sanders’ presidential campaign website included an “Issues” entry entitled “Medicare for All.” But while assuring quality health care for all Americans is a worthy concept, the devil is still in the details of how to pay for it.
That’s a tough enough challenge without losing significant sums of funding to fraud.
But as a front-page story in Saturday’s Wall Street Journal reported:
“The Justice Department on Friday unsealed charges in its largest-ever criminal health-care-fraud case, charging three individuals with using a network of doctors, hospitals and health-care providers across South Florida to improperly bill more than $1 billion to Medicare and Medicaid.”
And as Time magazine reported last month:
“Federal officials announced on [June 22] that 275 people around the country had been arrested in a crackdown on Medicare and Medicaid fraud. More than $800 million was falsely billed by those arrested for medically unnecessary services — or services that were never provided at all.”
Meanwhile, the Government Accountability Office has repeatedly warned that the Patient Protection and Affordable Care Act [ACA] is vulnerable to high-stakes fraud, too. The agency warned in a report early this year:
“With unresolved inconsistencies, CMS [Centers for Medicare Services, which oversees ACA applications] is at risk of granting eligibility to, and making subsidy payments on behalf of, individuals who are ineligible to enroll in qualified health plans.”
As for the latest high-profile allegations of Medicare and Medicaid fraud, from Monday’s Journal story: “Philip Esformes, the owner of more than 30 Miami-area skilled-nursing and assisted-living facilities, was the project’s mastermind, the indictment alleged. He and two co-defendants, along with other co-conspirators, allegedly paid and received bribes and kickbacks to get thousands of patients admitted to facilities Mr. Esformes controlled. In those facilities, they were often given medically unnecessary and sometimes harmful treatments, which were then billed to Medicare and Medicaid, according to court papers.”
It’s encouraging to know that the Medicare Fraud Strike Force is working hard to stop fraud and hold perpetrators to account.
But it’s apparently an overwhelming task. Since the task force was formed nine years ago, it has charged more than 2,800 people, asserting that they overcharged the national government — in other words, the taxpayers — by more than $10 billion.
And that hardly sounds like an “affordable” way to provide health care.