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December 4, 2012

Is the Government Reducing Medicare Fraud? Who Knows?


Republican Senators Orrin Hatch and Tom Coburn are trying to get some legally mandated answers from the Centers for Medicare and Medicaid Services (CMS). So far, so bad.

ObamaCare provided CMS with $77 million to initiate Medicare fraud prevention techniques in hopes of saving billions of taxpayer dollars, which, not coincidentally, would also help Medicare's long-term financial sustainability.

Marilyn Tavenner, the CMS acting administrator, was by law supposed to have a report to the Senate Finance Committee on October 1. No report arrived. On October 15, Hatch and Coburn sent Tavenner a strongly worded letter expressing their concerns.

It is now December and there is still no report.

In 2011, the Government Accountability Office released a report identifying $48 billion in "improper payments."  That's a little less than 10 percent of Medicare's budget-and a lot of money. And yet many analysts think that is just the tip of the iceberg. If the lion's share of those improper payments could be identified and stopped, it would amount to a huge savings for the program that has been blatantly negligent with respect to fraud.

For years CMS was required to follow a "pay and chase" model, where it paid virtually all Medicare claims and only initiated an investigation if it noticed something amiss. ObamaCare allows CMS to implement "predictive analytics," software that scans claims before they are paid looking for anomalies, double payments, inappropriate billing, etc.-something the private sector health insurance industry has been doing for years.

Ironically, it was ObamaCare supporters who claimed that private sector health insurers were inefficient while Medicare was the model of efficiency. No one-repeat, NO ONE-who knows anything about it actually believes that nonsense.

Some lawmakers are now boasting how they will cut government fraud and waste in an effort to control spending as part of budget deal to avoid the fiscal cliff. Don't hold your breath.

No one should be encouraged that the federal government is about to conquer innovative and fast-moving fraudsters when an agency that has been given millions of dollars to do so can't even get out a status report on time.


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