A NURSING HOME operator in northern California bilks Medicare
out of nearly $4 million.
And he might have got away with it if he hadn't submitted
forged invoices from bogus firms listing their addresses as New
Hamshire - without a "p" - and Lubbock, Miss., instead of Lubbock,
Older people in southern Florida are duped into giving their
Social Security numbers to door-to-door solicitors who say older
people are eligible for free milk. The conspirators use the numbers
to defraud Medicare out of $14 million.
A home health care service with operations in 22 states bills
Medicare for $85,000. Investigators later learn the money was used
to send gourmet popcorn to doctors to encourage them to employ the
According to the General Accounting Office, schemes like these
added 10 percent - or roughly $17 billion - to the cost of Medicare
last year. That's more than the federal government's total bill for
providing cash welfare help to poor families with children.
As members of Congress wrestle with competing plans for
overhauling the massive system that provides health care to the
elderly and disabled, they face an uncomfortable reality: Perhaps
no other government program is as rife with fraud as Medicare. But
the virtual impossibility of rooting it out means that reformers
must cut benefits deeper and squeeze providers harder to achieve
the kind of savings they want.
Republicans and Democrats alike claim that significant savings
can be achieved by ridding Medicare of waste, fraud and abuse, and
they are competing with each other to prove their prowess as
fraud-busters. But nonpartisan government accountants say the
proposed reform plans would do little more than scratch the surface
of Medicare fraud.
The Congressional Budget Office, for example, estimates that
the House GOP reform blueprint would recover only $2 billion of the
more than $120 billion likely to be stolen from Medicare over the
next seven years.
Some officials are warning that reform legislation could
actually make matters worse. The inspector general of the
Department of Health and Human Services contends that the House GOP
plan "would cripple the efforts of law enforcement agencies" to
control Medicare abuse and prosecute doctors and other medical
professionals who take kickbacks by placing an "unsurmountable
burden of proof on the government."
In fact, one section of the House reform package is titled
"limiting the imposition of anti-kickback penalties."
Gerald Stern, special counsel for health care fraud at the
Justice Department, said the House plan would seriously undermine
the current multiagency efforts to investigate and prosecute fraud,
which have won the government hundreds of millions of dollars in
Congressional Democrats are using the issue to attack their
Republican colleagues. At a congressional hearing last week, Sen.
Tom Harkin, D-Iowa, said the Republican plan "could be more
appropriately called the Scam Artists Protection Act. …