Tools To Fight Medicare Fraud Will Save Billions In The Long Run

April 11, 2012

Daily Camera, Boulder, Colo.

April 11--A courtroom drama winding its way through the Boulder County Justice Center this week might become more common around the country in the near-term, if the U.S. Supreme Court decides that all, or some, of the Affordable Care Act is constitutional.

If the act is thrown out altogether -- and we hope that it is not -- the so-far phantom alternative being proposed by "Obamacare" opponents would do well to uphold the increased tools to fight Medicare fraud. Are the tools free? No. Will they save the health care system and all rate payers well over and above what fighting fraud will cost? If recent history is any guide, there is to be no doubt.

In Boulder, a local social worker has been accused of exaggerating or fabricating services she provided to clients, in order to gain payment from Medicare, the federal health insurance program for American seniors. The lawyer for Karen Stevens says she is not guilty of fraud -- she received $194,184 from Medicare from January 2007 to September 2009 according to the case -- but that she made mistakes in what is a complicated billing system.

Expect to see many more cases like this on the docket -- though it should be repeated that she has just been accused, not convicted. But all over the country, prosecutors are trying to catch up with Medicare fraud -- and hopefully it will be crafted into any health care plan that would succeed Obamacare if it's thrown out.

Certainly, the government has always shown an interest in fighting entitlement fraud. But in recent years, it has been investing in it, with results.

In February 2011, the Medicare Fraud Task Force brought criminal charges against 11 people in 19 cities alleging $225 million in false billing schemes, the largest to date.

Then, in February 2012, the Justice Department announced what is now considered an even larger fraud, indicting a Dallas-area physician for running a web of false home health care services. The cost to Medicare: Nearly $375 million, according to the indictment.

During that announcement this year, Attorney General Eric Holder reported that in the last fiscal year alone, the government had recouped more than $4 billion through restitution and fines.

That's $4 billion in one year, for the second year in a row -- an estimated $7 for every $1 spent to fight fraud, according to the Justice Department.

What does this have to do with Obamacare? The controversial act included $350 million spread over 10 years to fight fraud, including hiring agents to help prevent and identify it. It includes heavier penalties to those found guilty and increases scrutiny over the programs receiving funds.

Those Congressional critics and presidential contenders who decry "government spending" should crunch the numbers. Medicare isn't going away: And investing in fighting fraud has turned out to be money well spent.

-- Erika Stutzman, for

the Camera editorial board


(c)2012 the Daily Camera (Boulder, Colo.)

Visit the Daily Camera (Boulder, Colo.) at

Distributed by MCT Information Services

Source:  McClatchy-Tribune Information Services
Wordcount:  505


Comment on this article




Featured Offers