Deep cuts at agency responsible for investigating health-care fraud

Deep staff cuts are hitting a federal agency responsible for investigating health-care fraud just as Obamacare is due to kick in, leaving less people to investigate an ever-growing crime that costs taxpayers billions of dollars.

And in a perverse twist, the funding cuts at the Health and Human Services Department's Inspector General's Office might save money in the short term for the U.S. taxpayer. But over the long run, more money that could have been recouped from the fraud cases now going unpursued, is being left on the table, the agency said.

For every $1 spent on health-care fraud probes, nearly $8 is recouped in fines, restitution or settlements, according to HHS.

"With fewer agents we investigate fewer cases, and with fewer cases we're likely to have fewer convictions, few civil settlements, which will likely translate into less recoveries," said Gary Cantrell, deputy inspector general for investigations at HHS, which investigates Medicare and Medicaid fraud.

"The problem is certainly growing . . . yet our resources are declining."

The Office of Inspector General is halfway to its goal of reducing staff by a total of 400 people from a previous level of about 1,800 employees. The cuts, which may continue into 2015, are being made because OIG is faced with $30 million in expiring funding streams, another $25 million in funds that have been authorized but not appropriated since 2009, and about $15 million in cuts as a result of the federal government's sequestration spending reductions.

(Read more: Medical ID theft could kill you)

Staff for Sen. Tom Harkin, D-Iowa, noted that the Appropriation Committee subcommittee on health that he chairs "is trying to make up for the expiring funding streams" by including tens of millions of dollars in spending increases for OIG.

But there is no guarantee those increases will make it through the Senate, much less be approved by a Republican-controlled House of Representatives.

Play Video
Cheating the health care system
CNBC's Andrea Day reports the Feds are fighting back against tax fraud. One pharmacy owner allegedly had customers bring in their prescriptions for cash.

The dollar amounts being cut from OIG's budget are a pittance compared to the amount of money that can and has been recovered by the government in health-care fraud cases, and compared to the tens of billions of dollars lost in Medicaid and Medicare fraud each year.

Millions on the line

The money at stake varies. In 2012, drug giant GlaxoSmithKline agreed to pay the U.S. government a whopping $3 billion for, among other things, promoting antidepressant prescriptions to children despite those drugs not being approved for kids.

While the GSK case is a high-water mark, it is not unusual for health-care fraud cases to recoup millions of dollars.

Earlier this year, for example, a judge slapped a $17.3 million fine on corrupt Detroit-area pharmacist Babubhai Patel as he sentenced Patel to 17 years in prison for fraud involving Medicare, Medicaid and private insurance.

With the roll-out of Obamacare, which will expand Medicaid enrollment rolls, as well increase the number of people with private medical insurance, Cantrell and others expect there to be even more opportunities for fraud.

(Read more: The new health-care scam that's ripping off taxpayers)

"We already turn down work that we can't proceed on. It's only going to increase with the continued expansion of the Medicaid program because of the Affordable Care Act," Cantrell said.

"Last year, we closed over 1,200 complaints because of lack of resources," Cantrell said. "That number's going to be pretty high this year as well, likely to exceed 1,000."

Louis Saccoccio, president of the National Health Care Anti-Fraud Association, a private-public partnership, said the cut to OIG's budget "doesn't make any sense."

"You're spending close to half a trillion dollars on Medicare, and another $400 billion or so in Medicaid. You have to invest in ensuring the integrity of these programs," Saccoccio said. "When you have this amount of investment, it just doesn't make much sense to cut."

Former U.S. Senate Majority Leader Bill Frist, a Tennessee Republican who is also a cardiothoracic surgeon, predicted, "Substantial cuts will translate into greater abuse, waste and fraud."

Health at risk

At stake in those cuts is not just the dollars lost.

"The bottom line to all this is, besides the money, the public health," said Lauren Mack, who heads health-care fraud prosecutions for the Brooklyn District Attorney's office in New York City, which often partners with federal authorities.

"We find doctors who are diluting flu shots, pharmacists putting out tainted pills," Mack said. "We have had people giving pacemakers to people who don't even have heart problems."

"There are 774 pharmacies in Brooklyn," Mack said. "There are a lot of bad little shops. Those little frauds, those little crimes add up. That's a constant bleed. If you don't have these people closed down by agents, that amounts to a big bleed—that's a gusher."

OIG's Cantrell said that while his office's value often is measured in fines and settlement amounts in the millions of dollars or more, another measure is reductions in unnecessary Medicaid and Medicare reimbursements.

Cantrell noted that in 2011 Miami resident Lawrence Duran was sentenced to 50 years in prison for a $205 million Medicaid scam involving his community mental health company American Therapeutic. Duran also was ordered to pay $87 million in restitution.

(Read more: Obamacare is coming and so are the con artists)

Duran's scheme, which involved bogus Medicaid claims, was brought down by the Medicare Fraud Strike Force, a joint HHS and Justice Department effort that operates in nine metropolitan areas and has lead to charges against more than 1,500 people for more than $5 billion in false billings since the unit began in 2007.

"We saw this scheme, and others like it in south Florida and Louisiana," Cantrell said. "Largely as a result of law-enforcement efforts, we saw significant reductions of Medicare outlays."

In other words, after Duran was busted, other community mental health centers reduced their billings to Medicare, a possible sign that at least some of them may have been engaging in fraud.

http://www.cnbc.com/id/101041552

Views: 53

Reply to This

"Destroying the New World Order"

TOP CONTENT THIS WEEK

THANK YOU FOR SUPPORTING THE SITE!

mobile page

12160.info/m

12160 Administrators

 

Latest Activity

Doc Vega posted a blog post

Death of an F-106 Pilot in Pursuit of the Unknown

 The year in between 1970 and 1972 on July 14 on a single night when a series of events led to the…See More
2 hours ago
Tina Sullivan left a comment for Less Prone
"Hey, buddy!  You're right, I can't get into my account!  "
7 hours ago
rlionhearted_3 posted photos
10 hours ago
Doc Vega posted a blog post

The Re-Evaluation of our Current Reality

 Surprisingly, there has been talk of mankind being enveloped in an artificial reality for decades…See More
yesterday
tjdavis posted videos
yesterday
Sandy posted a video

Source: Havana Syndrome investigation is "a massive CIA cover-up" | 60 Minutes

For years, the U.S. government has doubted the stories of those suffering from AHI, commonly called Havana Syndrome. Now, victims hope that reports of a newl...
yesterday
Doc Vega posted a blog post

Regrets That Cling to Me

Talking with my shadow in the nightI know it sounds contriteA vacuum without the lightThe silence…See More
Monday
tjdavis posted a photo
Monday
Doc Vega posted a blog post

Reality Is now Becoming Unhinged

 Let’s take a trip down the modern-day rabbit hole we call everyday news and events, but on a more…See More
Sunday
cheeki kea commented on Sandy's video
Thumbnail

Ghislaine Maxwell & The Secret "Shadow" 9/11 Commission? | John Kiriakou

"You tuber Sabby Sabs sums up and joins dots. Don't miss this one."
Sunday
Doc Vega posted a blog post
Mar 5
Burbia commented on TommyD's group The Chuckle Hut
"The Warriors is one of my favorite movies. I couldn't help but laugh at this spoof."
Mar 4
Doc Vega posted a photo
Mar 4
Doc Vega commented on Doc Vega's blog post Are the End Times Drawing Near?
"cheeki kea, You might want to see predictions made by Robert Welch in 1957 and 1974 stating that…"
Mar 4
Doc Vega commented on Doc Vega's blog post Are the End Times Drawing Near?
"cheeki kea, good points. We have a world full of twisted allied agendas that seem contradictory,…"
Mar 4
Sandy posted a video

Ghislaine Maxwell & The Secret "Shadow" 9/11 Commission? | John Kiriakou

In this gripping excerpt from the Julien Dorey podcast, former CIA officer and whistleblower John Kiriakou reacts to a leaked email from 2003. The document r...
Mar 3
cheeki kea left a comment for Holyroller
"Greetings to you Holyroller very awesome you've joined up with us all. I know you'll find…"
Mar 3
cheeki kea commented on Doc Vega's blog post Are the End Times Drawing Near?
"Yes it's a sad and sorry situation we see evolving here. On one front and it's a large…"
Mar 3
Doc Vega commented on tjdavis's video
Thumbnail

When the Communists Take Over America!...Famous 1957 Anti-Communist Movie

"I remember this when I was a little seeing it on TV years after it was filmed and it scared me even…"
Mar 3
tjdavis posted a video

When the Communists Take Over America!...Famous 1957 Anti-Communist Movie

Starring Jack Webb and Robert Conrad, this 1957 movie by the United States Armed Forces Information Agency is perhaps the best known anti-communist movie eve...
Mar 2

© 2026   Created by truth.   Powered by

Badges  |  Report an Issue  |  Terms of Service

content and site copyright 12160.info 2007-2019 - all rights reserved. unless otherwise noted