Newspaper logo  
 
 
Local Stories, Events

Ref. : Civic Events

Ref. : Arts & Education Events

Ref. : Public Service Notices

Books, Films, Arts & Education

01.21 The DeVos and the Defrauded [Corruption is now banal...]

01.20 A Swelling Tide of Major Teacher Strikes Is Shifting Our Politics Against the Charter Agenda

Letters

Ref. : Letters to the editor

Health Care & Environment

01.22 How Orkney leads the way for sustainable energy

01.22 Greenland's ice melting faster than scientists previously thought – study

01.22 David Attenborough tells Davos: ‘The Garden of Eden is no more’ [2:21 video]

01.21 35,000 Hit Streets of Berlin to Demand Agricultural Revolution

01.20 Doctors are frightened by climate change. Their industry is a big part of the problem.

01.18 Learning From Cuba’s ‘Medicare for All’

01.17 As Planet Heats Further, Even Davos Elite Warns Humanity Is 'Sleepwalking Into Catastrophe' [Intelligent government is desperately needed]

01.17 Could a Green New Deal Save Civilization? [Intelligent government is desperately needed]

01.17 New plant-focused diet would ‘transform’ planet’s future, say scientists

01.17 Studies Show Ice Melting and Ocean Warming Both Happening Much Faster Than Previously Thought

01.16 Immediate fossil fuel phaseout could arrest climate change – study [Intelligent government is desperately needed]

01.16 Our oceans broke heat records in 2018 and the consequences are catastrophic [charts]

01.15 Solar Farms Shine a Ray of Hope on Bees and Butterflies [Wonderful!]

01.15 Australia could hit 100% renewables sooner than most people think

01.15 Ion age: why the future will be battery powered

01.15 Barclays on wrong side of history with climate policy, says Greenpeace

01.15 'One fish at a time': Indonesia lands remarkable victory

01.15 Insect collapse: ‘We are destroying our life support systems’

01.14 V.A. Seeks to Redirect Billions of Dollars Into Private Care [The most public and efficient healthcare in America has been demonized and will be destroyed rather than improved, raising total  per-capita costs]

01.14 Saudi Arabia Increases Solar Targets To 20 Gigawatts By 2023 & 40 Gigawatts By 2030

01.14 Solar + Storage Half The Cost Of Gas Peaker Plants — 8MinuteEnergy

01.14 Why thousands of Los Angeles teachers are going on strike [Well at least we got a big tax-cut for the super-rich, that was the most important thing.]

01.14 Air pollution 'as bad as smoking in increasing risk of miscarriage'

News Media Matters

01.19 How conservative media became a “safe space”

Daily: FAIR Blog
The Daily Howler

US Politics, Policy & 'Culture'

01.22 'Medicare for All and Equal Rights Aren't Trends': Ocasio-Cortez Fires Back After Aaron Sorkin Lectures Young Progressives [Morality is not a trend, it is a state of being we should all aspire to]

01.22 'Literally What Jesus Told People to Do': In Arizona, Possible Prison Time for Leaving Food and Water for Migrants

01.22 White students in MAGA gear crashed the Indigenous Peoples March and harassed participants [3:44 video; we must stop growing/programming more sociopaths]

01.21 Trump’s One Legislative ‘Win’ Is Actually a Failure

01.21 TRUMP 'HAS ISOLATED AMERICA AND TAKEN US BACKWARDS,' FORMER SECRETARY OF STATE KERRY SAYS

01.21 The 'exhausting' work of factcheckers who track Trump's barrage of lies

01.20 REPUBLICAN SAYS TRUMP IS 'INCAPABLE' OF ARTICULATING A PLAN TO END GOVERNMENT SHUTDOWN

01.20 Institute Index: The Racial Injustice of the Government Shutdown

01.19 The shutdown’s effect on the US economy, explained

01.19 The Biden Band-Aid: Will Democrats Contain the Insurgency?

01.19 Donald Trump Has Never Cared About Workers, and Never Will

01.19 Republicans’ lack of alarm over the shutdown reveals a disturbing truth [Sociopaths have little or no conscience, empathy or morality...]

01.19 Arizona: Four women convicted after leaving food and water in desert for migrants [morality is against the law]

01.19 Mueller breaks silence to dispute parts of bombshell report on Michael Cohen

Justice Matters

01.19 Merkley Calls for FBI Perjury Probe into Homeland Secretary Nielsen After Child Detention Memo Leaked

High Crimes?
Economics, Crony Capitalism

01.22 The System’s Falling Apart: Were the Dogmatic Marxists Right After All?

01.22 The shutdown has exposed the disaster that is Trumponomics

01.21 World's 26 richest people own as much as poorest 50%, says Oxfam

01.17 Trump's economy is great for billionaires, not for working people [chock-full of pesky facts that government and media ignore and distort]

International & Futurism

01.22 Labor promises to 'supercharge' hydrogen industry as green groups say 'no role for coal'

01.22 Who is more dangerous: El Chapo or Carlos Slim? [Like Drug Gangs, Mafias harm and kill the public too—but slowly and quietly like leeches]

01.22 Martin Luther King was no prophet of unity. He was a radical [He was—and We must be—passionate and pro-active for improving moral conduct in society!]

01.19 The Ebola outbreak in Eastern Congo is moving toward a major city. That’s not good.

01.19 Ahead of Third Annual Women's March, Group Releases Far-Reaching 'Intersectional Feminist Policy Platform'

We are a non-profit Internet-only newspaper publication founded in 1973. Your donation is essential to our survival.

You can also mail a check to:
Baltimore News Network, Inc.
P.O. Box 42581
Baltimore, MD 21284-2581
Google
This site Web
  Slick Barry and the $100-Billion Medicaid/Medicare Fraud Claim

COMMENTARY:

Slick Barry and the $100-Billion Medicaid/Medicare Fraud Claim

by Dave Lindorff
Originally published in This Can't Be Happening yesterday, 11 March 2010

The $100 billion “fraud” figure comes from a study done annually by the Centers for Medicare and Medicaid Services (CMS), and that study makes it clear that it is not looking at fraud, but at errors involving problems like illegible signatures on doctors’ orders, or lost paperwork.

President Barack Obama is out and abroad stumping like mad for his embattled health insurance “reform” plan, claiming now that his administration will “crack down” on $100 billion in annual “waste and fraud” in the Medicare and Medicaid systems.

This new tough anti-government rhetoric is meant to win over some of the conservative opposition that sees all government programs as inherently wasteful, inefficient and corrupt.

But the claim itself is bogus.

The figure comes from a study done annually by the Centers for Medicare and Medicaid Services (CMS), and that study makes it clear that it is not looking at fraud, but at errors. And there are two things that can be said about those errors, most of which appear to involve problems like illegible signatures on doctors’ orders, or lost paperwork needed to document that a treatment being billed for actually happened.

The first point to make here is that such errors are equally prevalent in the private sector, only the chances are that in the private sector, the errors more often lead to shortchanging or denying care to the patient, while in the public sector, they as often lead to somebody or some institution getting paid more than they deserve for treating a patient.

Second, the errors in the Medicare program (there has been no systematic study, according to a spokesman at CMS, of error and fraud in the Medicaid program, much of which is funded and managed by the various states), cut both ways, with some errors leading to an overpayment or a payment for a service that wasn’t actually provided, and some errors leading to an underpayment for a service that was provided. Also not reported at all are errors that led to a person’s being improperly denied care altogether. (The same is true for the Veteran’s Administration, by the way, which is notorious among veterans for improperly denying claims of service-connected disabilities.)

According to the latest CMS report, the error rate for Medicaid parts A and B--the hospital and physician part of the program--was 7.9 percent or approximately $24 billion. Of this, $23 billion was said to involve overpayments, and $1.1 billion was said to involve underpayments. The underpayment figure looks suspicious, because in prior years, when the overpayment figure was roughly $9-$10 billion annually, the underpayments came in at about $1 billion also. It seems unlikely that overpayment errors in 2009 would more than double, while underpayment errors would stay the same.

Nearly all the underpayment errors--$800 million worth in 2009--were for inpatient care. This compared to $6 billion in overpayment errors. In otherwords roughly two out of every 15 errors involved the patient or the patient’s physician or hospital being shorted by Medicare.

CMS claims that the estimated error rate for Medicaid in 2009 was 8.7% for the federal government and 10.5% for the states and counties that administer the program locally. That would be $39 billion of the $98 billion in errors and fraud found in both programs combined for the year by CMS, and cited by President Obama in his “$100 billion in waste and fraud” claim.

But bear in mind that unlike Medicare, Medicaid is a welfare program, which means that the bias is towards denying benefits to applicants, as anyone who has had experience with Medicaid can tell you. Furthermore it is a program administered by both state and federal bureaucrats.

Back in 1977, when I was county government bureau chief for the Los Angeles Daily News, I got an urgent call from my editor, telling me to hop on a story based upon a release by the L.A. County Department of Social Services claiming to have discovered that 5.83 percent of welfare recipients were being overpaid because off errors and fraud, and that a campaign was being implemented to attack the problem, which was costing the county millions of dollars a year. Naturally, the editor saw this as a page-one piece, perhaps a banner headline, for the next day's edition. I called the head of the Department of Social Services and asked a simple question: What is the error rate in the other direction? What percent of welfare applicants and recipients were being undercompensated because of errors? After a little investigation, she returned and informed me that the underpayment error rate was exactly the same: 5.83%! When I reported this back to the City Desk, there was an audible groan on the phone. The story had lost all importance to the editor. And yet, I thought, wasn’t an underpayment of welfare benefits to a poor family of far greater consequence than an overpayment is to the taxpayers? Getting shorted $100, or even $20, for a family living on, or below, the edge, would be catastrophic.

My guess is that a good study of underpayments and overpayments in the Medicaid program of the federal government and the states would more than likely give the same kind of result: an error rate in terms of underprovision of benefits that is equal to in percent and dollar amount the overpayment of benefits. And in fact, with welfare type programs like Medicarid, there is also an unmeasured or unmeasurable problem, which is people who are wrongly denied benefits at all. They aren’t underpaid because they are simply turned away from public assistance for health care when they are actually eligible.

The point here is that if there is an error rate of about 9.5% in Medicaid (I’m averaging the federal and state error rate estimates for 2009), then either half of that $39 billion is probably underpayment errors, or, if they are only counting overpayment errors, there is almost certainly another $39 billion that should have been paid out for care of poor families that was not paid out.

Either way, the president’s incendiary claim that there is $100 billion in waste and fraud in the Medicare and Medicaid program is way off the mark.

If the president were serious about the problem, he would call for an honest investigation to make certain that everyone potentially eligible for medical coverage and assistance in both programs gets the full benefits to which they are entitled, to minimize inadvertent overpayments to providers, and to prosecute to the full extent of the law those who defraud either program.

That would be fine and appropriate. But at the same time, the president is also disingenuous in the extreme when he just attacks fraud and waste in Medicare and Medicaid, as though there is not massive fraud and waste in the private insurance industry and the rest of the medical industry (not to mention the defense industry, where the waste and fraud in one weapons program can dwarf all fraud and waste in the health care budget combined). Indeed, much of the fraud in the Medicare program is in that part of it that is contracted out to the private insurance firms that offer the so-called MediGap insurance policies. Nearly all the rest of the actual fraud is perpetrated by private physicians, private hospitals and by other medical industry firms and pharmaceutical companies, which submit false invoices and charge for services and goods not delivered. And as CBS’s “60-Minutes” program and other news organizations have reported, there has been little or no effort devoted to prosecution of such fraud, though it totals in the tens of billions of dollars per year.

That’s not a problem with “government-run health care”--a bogeyman that the president regularly pulls out to pillory--but with private healthcare.

The president knows this, but since his whole “reform” proposal is built around the private insurance sector, he’s not going to say that.

Then again, what political strategist guru in the White House came up with the idea that attacking alleged “waste and fraud” in “government health care” would be a good way to win support for Obamacare?


Dave Lindorff in Washington

About the author: Philadelphia journalist Dave Lindorff is a 34-year veteran, an award-winning journalist, a former New York Times contributor, a graduate of the Columbia University Graduate School of Journalism, a two-time Journalism Fulbright Scholar, and the co-author, with Barbara Olshansky, of a well-regarded book on impeachment, The Case for Impeachment. His work is available at www.thiscantbehappening.net.



Copyright © 2010 The Baltimore News Network. All rights reserved.

Republication or redistribution of Baltimore Chronicle content is expressly prohibited without their prior written consent.

Baltimore News Network, Inc., sponsor of this web site, is a nonprofit organization and does not make political endorsements. The opinions expressed in stories posted on this web site are the authors' own.

This story was published on March 12, 2010.
 

Public Service Ads: