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Unchecked Medicare Fraud is Government Run Amok

Unchecked Medicare Fraud is Government Run Amok

In today’s world, federal agencies in the Obama era are the spending equivalent to Genghis Khan. So why is the administration dragging its to stop Medicare fraud and save the taxpayer billions?

Two words: Hospital. Lobby.

This week, the Centers for Medicare and Medicaid Services (CMS) announced it was extending a “freeze” on the so-called “Two-Midnights” rule, the latest in a long series of delays.

Under the rule, doctors must expect patients to stay in the hospital for two days, or as they say, two “midnights,” in order to be eligible for Medicare Part A payments. While the technical details are complicated, it closes a billing loophole that netted hospitals billions of illegal payments before it was spotted by auditors.

It’s no surprise that since its enactment in 2013, the hospital lobby has poured millions into a lobbying campaign to water-down or kill the “Two-Midnight” rule, including targeting the auditing program that flagged the payments, simply because it is too effective. Imagine that?

For example, hospitals are pushing a bill to gut the “Recovery Audit Contractors” (RAC) program that pays private auditors a portion of fraudulent funds they help the government recover. Essentially incentivizing good work that saves taxpayer money and doesn’t cost the government a dime…Sounds like a dream program to me.

Medicare fraud is estimated to cost taxpayers $50 billion annually. To put that into perspective, that’s about ten times the amount the Navy spends on submarines in a year.

Given the enormous scale, conservatives need to pay attention to a relatively obscure battle like this as part of the broader struggle for limited government, especially since they were elected to a majority to put the federal government in check.

The RAC program, a small oasis of sanity in the desert of flagrant government waste, was actually instrumental to the original (though now delayed for years) rule, as the auditors identified the improper payments that were a result of the billing loophole.

Of course, these fraudulent payments are essentially a profit margin to the hospitals that are paid the money.

So what did they do?

They went out and hired a small army of lobbyists to swarm Capitol Hill and the agencies seeking to stop the auditing.

One particularly infuriating tactic they’ve employed is filling up the appeals dockets for the audits with frivolous claims, only to then seize on delays in appeals processing as the reason Congress should water down the program.

Nancy Griswold, the government’s chief administrative law judges for the appeals, disclosed in a recent Senate hearing that “51 percent of our incoming appeals have been filed by five appellants.”

Seems fishy doesn’t it?

$50 billion a year is being stolen from taxpayers and its beneficiaries are simply counting on the public to remain distracted in perpetuating their special deal.

Although this specific issue relates to Medicare, with Obamacare, you can expect to see lots more of this type of special arrangement in the future.

Taxpayers need to stay vigilant to stop this Genghis Kahn reign of free spending and capture of the Obama Administration by K Street lobbyists.


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