Q&A: Medicare fraud evolves
Q: How big of a bite does waste, fraud and abuse take out of Medicare?
A: As a taxpayer watchdog, I learned long ago that fraudsters look for any loophole they can find to bilk the U.S. Treasury. That’s why I use my legislative and oversight authority to improve fraud-fighting tools to root out wrongdoing, especially in the areas of federal defense and health care spending. Let’s consider Medicare for which the Department of Health and Human Services (HHS) estimates improper payments exceed tens of billions every year. About 60 million Americans depend on this federal health program to help pay for hospital and doctor visits, prescription drugs, home health care, hospice and more. Medicare accounts for 15 percent of the federal budget and about 20 percent of national health spending. In 2018, total Medicare benefit payments reached $731 billion, including payments for durable medical equipment, rural health care clinics and outpatient therapy, among other health care services. For decades, bad actors have cranked the Medicare spigot to fill their own pockets. Every dollar siphoned off to waste, fraud and abuse rips off the taxpayer, shortchanges Medicare beneficiaries and gives honest health care providers a black eye. That’s why I keep check on how the federal bureaucracy manages your money. As far as I’m concerned, the federal government needs to stretch each and every tax dollar. When I get a whiff of wrongdoing, I track it down to help fix what’s broken. When I chaired the Senate Finance Committee in 2004, I examined explosive spending in Medicare’s power wheelchair program. The astonishing growth rate of 450 percent over a four-year period didn’t pass the common sense test. Fraudsters were exploiting lax enforcement to make a fast buck at taxpayer expense. A few years later, I shined my oversight lens on phantom pharmacy schemes. Crime rings and corrupt health care professionals were in cahoots to submit fake prescriptions for untold millions of dollars. Keeping the lid on health care fraud is one way to help lower the lid on rising health costs in America. Fraud also leads to higher premiums and higher out-of-pocket costs. Considering the difficulty the federal government faces to clamp down on Medicare fraud, every taxpayer in America ought to be concerned about busting open the federal treasury to pay for so-called “Medicare For All.”
Q: What kinds of Medicare fraud have you sunk your teeth into most recently?
A: Unfortunately, there’s no rest for the weary when it comes to defending taxpayers from fraud. As long as I’m in the U.S. Senate, I’ll continue my efforts to strengthen fiscal management and prevent wrongdoers from milking the federal treasury like a cash cow. Earlier this year, I wrote HHS and the Centers for Medicare and Medicaid Services (CMS) to flag a new payment schedule for lab fees. I urged federal administrators to scrutinize the likelihood of significant overpayments due to inappropriate coding for individual diagnostic tests that should have been bundled. Specifically, the Government Accountability Office (GAO) estimated Medicare might be on the hook for a staggering $10.3 billion in overpayments if CMS fails to adequately ensure that lab tests are paid at a bundled rate rather than an individual rate for each of the panel’s component tests. On the heels of that $10 billion liability, the Department of Justice (DOJ) in September reported one of its largest-ever health care schemes ever charged, alleging 35 people unlawfully billed Medicare for $2.1 billion. The fraudsters exploited twin frontiers of our modern health care system, the expanding reach of telemedicine and genetic testing. The scheme used recruiters to dupe Medicare beneficiaries to accept “free” cancer screenings with a cheek swab. Then, a fake telemedicine company would use medical providers to order the expensive and medically unnecessary genetic test (for an illegal kickback payment). The scammers would use the patient’s Medicare information to fraudulently bill Medicare. The telehealth recruiter, health care provider and lab operator would split the pot and pocket the Medicare money. These scam artists preyed on the elderly, disabled and vulnerable Americans. They bilked Medicare out of billions of dollars, breaching the public trust and dimming confidence in our health care system. I’m glad the anti-fraud units within the DOJ and HHS found and exposed this crime ring. However, I am concerned it’s just another tip of the iceberg and I’ve written to HHS and CMS about it. We can’t afford to allow unscrupulous providers to undermine the integrity of telehealth services that are increasingly vital to the delivery of health care in rural and underserved communities.