Re: Report Criticizes Medicare Role in Fraud Investigations
- From: "Jerry Okamura" <okamuraj005@xxxxxxxxxxxxx>
- Date: Sun, 8 Nov 2009 15:56:49 -1000
A famous bank robber when asked why he robbed banks, supposedly said, "I rob banks because that is where the money is". Whether he said that or not, really does not matter, the point is the same. People will target stealing from where the money is, especially if the punishment for getting caught is not significant.
"arthur wouk" <awouk@xxxxxxxxxxxxxxxxx> wrote in message news:1257031528.414826@xxxxxxxxxxxxxxx
this took place under shrub, and is coming to light now:
Report Criticizes Medicare Role in Fraud Investigations
By GARDINER HARRIS
In 2006, after the federal government established a multibillion-dollar drug
benefit for older Americans, top officials promised to keep the program
honest by hiring private companies to investigate and root out fraud.
But government investigators are reporting that the Medicare program
largely failed to give those contractors much of the information they needed
to do their work.
In a report expected to be made public on Monday, Daniel R. Levinson, the
inspector general of the Department of Health and Human Services, said
that federal health officials needed to give antifraud contractors more data
and that the government should require private insurers to report all
instances of potential fraud to those companies.
Lawmakers have long complained that the government does not do enough to curb
fraud and abuse in its vast health programs for the elderly and the poor, and
the report supports some of those complaints. The Obama administration, like
many before it, has promised to improve its oversight of the programs.
"By mismanaging contractors, government officials are weakening the effort to
fight fraud against Medicare's prescription drug program," Senator
Charles E. Grassley, Republican of Iowa, said of the new report. "It'll
be another inexcusable waste of money if the bad management is allowed to
continue."
Shortly after the Centers for Medicare and Medicaid Services started the drug
benefit, the government hired several companies -- called Medicare drug
integrity contractors, or Medics -- to identify and investigate fraud in the
new program. The companies were expected not only to investigate complaints
from insurers and beneficiaries but also to pore over prescription drug
information on their own and find suspect buying patterns that might indicate
fraud.
To conduct their own investigations, the companies needed databases from both
the government's new drug program, called Part D, and an older one, Part B.
The government failed to give the companies access to data from the new
benefit until August 2007 -- nearly a year after their contracts began. Two
of the companies were not given access to data from the old benefit until the
fall of 2008, two years after their contracts started. The third company
never received Part B benefit data.
Even when the companies got these databases, much of the information they
needed to conduct their investigations was missing or erroneous, Mr.
Levinson's report stated.
In a response, federal officials agreed with some of Mr. Levinson's findings
but added that legislation could be required to follow through with all of
his recommendations.
The government's new drug benefit cost $49.5 billion in 2007 alone, and it
largely relies on private insurers to deliver benefits. Fraud contractors
were supposed to conduct audits to ensure that these private insurers were
trying to root out fraud themselves, but government officials did not allow
the audits to go forward in the 2008 fiscal year. Only in its last months in
office did the Bush administration authorize audits of private insurers'
efforts to crack down on fraud.
The three fraud contractors identified 4,194 incidents of potential fraud and
abuse and investigated 1,320, but few investigations resulted from the
companies' own findings. Ninety-six percent of its investigations resulted
from tips from people like Medicare beneficiaries, relatives or Medicare
contractors.
Copyright 2009 The New York Times Company
--
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