Wasteful spending

Wednesday, April 1, 2009 | 2:09 a.m.

It is crucial that the Obama administration and Congress take whatever steps are necessary to eliminate wasteful medical spending, especially when taxpayers are footing the bill. This challenge is no greater than in the arena of Medicare billing fraud, which represents the largest share of fraudulent activity against the federal government.

In a Sunday story in the Las Vegas Sun, reporter Marshall Allen wrote about two Southern Nevada physicians who have been accused of submitting bills to Medicare or other insurance programs for patient exams they did not conduct. Both doctors denied wrongdoing. Allen also mentioned eight other Las Vegas doctors who were accused in two separate cases of Medicare abuses. Two paid a combined $2 million to resolve their case and six paid $625,000 total in fines, but none admitted any guilt.

The problem is that Medicare fraud is often hard to prove. This problem is aggravated by the fact that the federal government devotes few resources to recruiting whistleblowers or making on-site investigations to unearth evidence of fraud, Pat Burns, spokesman for the national advocacy group Taxpayers Against Fraud, told the Sun.

“The idea that this is a victimless crime is nonsense,” Burns said. “This is costing every family in America thousands of dollars a year.”

The Web site for the federal Centers for Medicare and Medicaid Services says contractors are used to track inappropriate billing practices. But a string of investigations over the past year by Congress and its auditing arm, the Government Accountability Office, have found that the Medicare agency does a poor job of tracking fraud.

One study last year found that Medicare paid as much as $92 million in fraudulent claims since 2000 to suppliers of walkers, wheelchairs and other home medical equipment by failing to catch nearly 500,000 phony prescriptions that contained the identity numbers of thousands of dead doctors. Another study uncovered more than $1 billion in questionable claims because diagnosis codes that were used to help process payments did not match the conditions suffered by the patients.

None of this will change unless the Medicare agency is given the resources and marching orders necessary to eliminate fraud.