Prosecuting Medicare Fraud – The Untold Obama Administration Success Story

Merrill Goozner

First posted 8/24/11 on Gooz News

One wonders what the Obama administration has to do to get a little credit. I’m sitting on vacation, looking at the ocean most of the day, and spending about a half hour on line at night erasing unread emails, killing out unread RSS feeds, and checking up on my declining retirement prospects. Amid the clutter, a series of press releases from the Inspector General of the Health and Human Services Department caught my eye. Here are the headlines, with links (I’d link to the press coverage, but near as I can tell, there was none):

Miami-Area Doctor Pleads Guilty in $25 Million Health Care Fraud Scheme

Owner of Miami-Area Mental Health Care Corporation Convicted on All Counts for Orchestrating $205 Million Medicare Fraud Scheme

Miami-Area Medical Equipment Company Owners Sentenced to Prison for Medicare Fraud Scheme

That was Tuesday. On Monday, the HHS sleuths put out this press release:

FORMER CHAIR OF TEMPLE’S OPHTHALMOLOGY DEPARTMENT CONVICTED OF HEALTH CARE FRAUDPHILADELPHIA – A federal jury today convicted Dr. Joseph J. Kubacki, 62, of Destin, Florida, of 150 counts of health care fraud, wire fraud, and making false statements in health care matters, announced United States Attorney Zane David Memeger. Kubacki was the Chairperson of the Ophthalmology Department of the Temple University School of Medicine and also served as the Assistant Dean for Medical Affairs when, between 2002 and 2007, he caused thousands of false claims to be submitted to health care benefit programs with false charges totaling more than $4.5 million for services rendered to patients whom Kubacki did not personally see or evaluate. A sentencing hearing has not yet been scheduled.

Last month, the actuaries at the Centers for Medicare and Medicaid Services reported that costs grew by only 3.9 percent last year (not adjusted for inflation), the slowest rate of growth since the inception of the program. Health care as a share of the economy did not grow for the first time in years. In other words, health care costs last year were essentially “under control.”Think there’s any connection between slowing health care cost growth and fraud? Here’s a sentence from the final paragraph of the latest press release from the OIG. The “strike force” refers to the special unit set up in CMS to search out fraud, which has gotten a huge boost in funding and support during Obama’s first three years in office:

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion.

A billion here, a billion there. After a while we’re talking real money. It’s not that every doctor, hospital, clinic, or durable equipment supplier is a fraudster. But by cracking down on those who are, the rank-and-file Medicare practitioner begins to think twice about over-prescribing Medicare services for his or her patients.

About Brian Klepper

Brian Klepper is a health care analyst, commentator and a Principal in Health Value Direct.
This entry was posted in Market Dynamics, Physicians, Policy/Law/Regulation, Quality, Reform, Tools and tagged , , , . Bookmark the permalink.

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