It’s just begging to be exposed, as an important first step in cutting our unsustainable national debt.
Though some might still deny it, there is growing bipartisan belief that our nation’s level of indebtedness is unsustainable. How we reduce the debt burden is another matter; this is where political knives are sharpened.
Yet there is one uncontroversial issue that could result in dramatic savings and, interestingly is almost never mentioned: fraud, fraud in Social Security, Medicare, and Medicaid.
The Social Security Administration (SSA) manages cash benefits for people with disabilities accounting for approximately $150 billion. There are two programs in this category, Disability Insurance (DI) and Supplemental Security Income (SSI), the former for workers with disabilities including family members and the latter for individuals with disabilities who have limited income and resources.
Remarkably the GAO analysis of SSA and federal salary data found that 1,500 federal civilian employees are receiving funds improperly to the tune of $1.7million monthly or $20.4 million annually. This is approximately two percent of SSA fraud cases which demonstrates the magnitude of the problem. In fact, there are literally hundreds of SSI recipients who receive their checks in Mexico City, to cite one example, who haven’t resided in the United States in years and who never contributed a dime to the Social Security agency.
The most flagrant example of fraud in the Social Security system is identity theft. Invariably SS numbers are stolen and used to open credit cards. In a plurality of cases the numbers are stolen from minors with no credit history. A similar method is used with stolen telephone and utility bills.
In general, there are three ways to commit fraud in the Social Security system including identity theft: Issuing false statements; concealing the truth; mishandling payments. When you apply for disability, an application must be filled out based on a claim. If you claim you are disabled and unable to work, but still maintain a job, that is fraud.
No one at the GAO can give me an accurate estimate of fraud and the SSA admits it cannot monitor the fraud cases. Hence any estimate is likely to err on the conservative side. On SSI and DI alone, fraud probably accounts for at least 2 to 3 billion dollars. And this represents only two of the many Social Security programs, albeit the ones most likely to engender fraud cases.
Medicare fraud is rampant and as is the case with Social Security hardly ever prosecuted and generally undisclosed, despite estimates about abuse that appear in the Congressional Record. The fraud occurs when people or companies bill Medicare for services that were never provided or received or were unnecessary. Providers generally commit fraud when services are not given. A common practice is “gang visits” in which a provider visits a nursing home and bills for services to all or nearly all the residents. In this case services may not be performed or, more likely, the provider performs a service whether or not the resident needs it.
When my mother lived in a Florida retirement community, a well upholstered van would stop and the driver would call for her three times a week. I asked my mom why she went to the doctor’s office so frequently, assuming there was a health issue that had to be addressed. She said, “A nurse takes my blood pressure and asks me how I’m feeling. I don’t have much to do so this helps pass the time. After all, it’s free.” It may be free for her, but it is not free for tax payers. Moreover, whatever the expense for my mom has to be multiplied by 20 to account for the others in the van.
Another fraudulent act, which occurs routinely, is “upcoding a service,” i.e. bill for surgery when only a band-aid was placed over a cut. Similarly, unbundling services is a way to pad bills by suggesting three or four tests intended to be one service are billed as independent services.
Suppliers commit fraud when they bill for a qualitatively superior product, but offer the marginal variety or bill for equipment that has been returned.
Recruiters are a growing problem on the Medicare front. These people often go door to door offering money and gifts as incentives for “free” medical exams. Needless to say, Medicare is charged for this solicitation.
Because of the availability of government “soft” money, scams proliferate. There are advertisements for medical plans that have not been approved; there are misleading plans that have not been approved; there is misleading information that encourages fraudulent acts, e.g. when a company offers Part D prescription plans at no cost to beneficiaries, even though Part D plans require beneficiaries to pay premiums.
According to FBI records, there are about 2,500 pending fraud cases a year since 2003, most falling into the “upcoding” category in which a routine doctor’s office visit is billed as individual therapy. However, these cases represent the tip of the proverbial iceberg since upcoding is a common practice among health care providers. So too are kickbacks in which money is exchanged for the referral of patient services that will be paid by Medicare.
Medicaid has many of the same fraud issues as Medicare, with provider bills that were unnecessary or never performed. Under Medicaid, a healthcare provider is paid by the government for each service it performs. Billing the government for fictitious services can be highly lucrative, which explains in large part why each year another “nursing home scandal” appears on the front page of local newspapers.
A man of faith in a godless age is hitting Americans where it hurts.
Mr. and Mrs. American Spectator Reader, let P.J. O’Rourke talk sense to your kids.
In Britain, defending your property can get you life.
The debacle of this president’s administration is both a cause and a symptom of the decline of American values. Unless Congress impeaches him, that decline will go on unchecked. An eminent jurist surveys the damage and assesses the chances for the recovery of our culture.
It won’t take long for conservatives to scratch this presidential wannabe off their 2008 scorecard.
The American Christmas, like the songs that celebrate it, makes room for everybody under the rainbow. Is that why so many people seem to be hostile to it?
Was the President done in by the economy, or by the politics of the economy?