In his address to a joint session of Congress on February 24, 2009, President Obama, at the very outset of his administration, promised to “root out the waste, fraud, and abuse in our Medicare program that doesn’t make our seniors any healthier.” In recent days, we have begun to see the President’s promise become a reality.

Obama’s  F.Y. 2010 budget proposal, released on May 10, included a $1.7 billion increase over five years to the Health Care Fraud and Abuse Control Program. That program, under the joint direction of the Department of Justice and the Department of Health and Human Services, was established in 1996 by The Health Insurance Portability and Accountability Act of 1996 (HIPAA), under President Clinton.

On May 20, new Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to combat Medicare fraud. HEAT will build on efforts begun with significant success under the Bush administration:

The HEAT team will include senior officials from DOJ and HHS who will build upon and strengthen existing programs to combat fraud while also investing new resources and technology to prevent fraud, waste and abuse before it happens. Efforts will include the expansion of joint DOJ-HHS Medicare Fraud Strike Force teams that have been successfully fighting fraud in South Florida and Los Angeles. Established in 2007, these teams have a proven record of success using a “data-driven” approach to identify unexplainable billing patterns and investigating these providers for possible fraudulent activity. The Medicare Fraud Strike Force team operating in South Florida has already convicted 146 defendants and secured $186 million in criminal fines and civil recoveries. After the success of operations in South Florida, the Medicare Fraud Strike Force expanded in May 2008 to phase two in Los Angeles, where 37 defendants have been charged with criminal health care fraud offenses. To date in the Los Angeles cases, more than $55 million has been ordered in restitution to the Medicare program.

“We know these strike forces work. I believe a targeted civil and criminal enforcement strategy in these locations will have a substantial impact on deterring fraud and abuse, protecting patients and the elderly from scams, and ensuring that taxpayer funds are not stolen,” said Attorney General Holder.

Republican Congressman Peter Roskam recently established his “Medi-FraudAlert” blog on his Congressional web site as a “forum to discuss the massive waste, fraud and abuse in the current Medicare and Medicaid systems”. Roskam absurdly states these costs could reach $500 billion annually. (The total cost of Medicare is only about $450 billion.) But the costs of fraud are significant – 3% or more of total health expenditures, 10.5% of federal Medicaid expenditures by one estimate. Roskam’s blog does a good job of highlighting some of the Obama administration’s early successes in combating fraud:

June 25:  A day after a $100 million fraud was exposed, yesterday, 53 people were indicted in a $50 million Medicare fraud scheme spanning from Detroit to Miami. The scheme involving patients, doctors, medical assistants and company owners, focused on Medicare claims submitted for unnecessary or never delivered treatments mostly for HIV-related drugs and physical therapy treatments.

June 29: Friday, eight Miami-area residents were arrested and charged with attempting to defraud Medicare for $22 million – having already paid out $15.3 million of those claims from Medicare. The Miami Herald reports that this was the prosecutors’ “first crackdown on home healthcare offenders in a decade.” In this case, two firms were raided, had their bank accounts frozen, and stand accused of filing bogus claims mostly for homebound diabetic services. ABC Home Health Care submitted $17 million in false claims since January 2006, and has already been paid $11.3 million in taxpayer money. Florida Home Health Care Providers filed $5.5 million in false claims since October 2007, being compensated with $4 million of taxpayer money.

June 30: Yesterday, a Miami doctor was sentenced to eight years in prison and ordered to pay more than $9 million in restitution for his part in a Medicare fraud scheme where he ultimately filed $20 million in false claims. The physician, Roberto Rodriguez, billed for fake HIV infusion services at six Miami-area HIV infusion clinics.

But Roskam, of course, has not created this blog because he wants the public to know how effective the administration has been so early in combatting fraud. Rather, Peter Roskam is using the existence of Medicare/Medicaid fraud as an excuse to subvert Democratic efforts to make quality healthcare coverage available to all American citizens, something to which he is ideologically opposed.

Roskam appeared this morning on WBIG 1280 AM this morning promoting his blog. He bemoaned the fact that physicians are reimbursed at such a low rate by Medicare and Medicaid due to the excessive expenditures on fraud and abuse and reiterated that he thought it unwise to pursue universal coverage with fraud so rampant. Roskam offered no solutions however for the 45 million Americans who have no health coverage. He did not even acknowledge them. Under the Roskam plan, they are on their own. You can listen to Roskam here:

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I think Roskam’s focus on Medicare fraud is a lame excuse for not doing what basic justice and decency require – that we provide healthcare to every American. If you agree with me, I encourage you give Peter Roskam a call and demand universal coverage now.  Tell him we’ve got blogs aplenty, we need a health plan. (You can attempt to post a comment on his blog but I expect that will be a waste of time as they are screening out unfavorable comments).  You can reach Peter Roskam at (202) 225-4561 in Washington or at (630) 893-9670 in Bloomingdale.

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