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Medicare Fraud: Going Where the Money Isn't
The NYT has a nice piece reporting how the Bush administration has opted not to try to collect tens of millions of dollars in excess payments to insurers operating within the Medicare program that were uncovered in random audits. As the article points out, the reason for not trying to take back these excess payments to insurers is not clear.
The same article points out that Medicare is actively pursuing 135,000 beneficiaries for money they owe for the Medicare prescription drug benefit. The money was supposed to have been taken out of their Social Security checks, but the agency made a mistake and failed to deduct the insurance premiums.
Juxtaposing these two cases is an effective way to put both in a context that readers can immediately understand.
--Dean Baker
COMMENTS (7)
To be a little fair, the Bush administration DOJ has been overall very agressive on Medicare fraud, as a continuation of the Clinton administration (I'm a bit of an expert in this area).
This particular area I'm not certain about, some of the random audits are not that defensible (for at least 30 years by the way).
Posted by: save_the_rustbelt | September 10, 2007 9:24 AM
Yes, but the story's point is that CMS, in response to the audits, are not pursuing the insurance companies for their failing to plow their excess payments into either rebates to seniors or additional services, while the agency is going after senior "deadbeats" who don't pay their drug co-pays. My question is why did the Times buy the story, and Robert Pear fail to mention the "justaposition" in the lead. It almost writes itself: "While the Bush administration is giving insurance companies that fail audits of their controversial Medicare health maintenance plans a pass, it is cracking down on seniors who fail to make co-pays on the recently-enacted drug benefit."
Posted by: Merrill | September 10, 2007 10:55 AM
that should have been, why did the Times "bury" the story . . . not buy.
Posted by: Merrill | September 10, 2007 10:57 AM
Yes, Merrill is right, the story was buried well inside the paper. Since the NYT doesn't give page numbers on its website, I didn't know where it ran until I got my paper this morning.
Posted by: Dean Baker | September 10, 2007 12:26 PM
A sort of quick way to check page numbers on the NYT website is to go to "Today's Paper":
http://www.nytimes.com/pages/todayspaper/index.html
Below the large section on the front page articles, you'll see page numbers listed for previous articles (from today's paper, or you can select papers from a few days before). You can therefore also determine whether the article in question is in print, or only published online.
Posted by: Ben Zipperer | September 10, 2007 5:18 PM
Were Medicare a business, some mid-level exec would do a cost/benefit analysis of trying to recover the excess insurance payments. If that analysis looked promising to upper management then a smalish trial program would be ran. If that panned out then a program to go after everything would go into effect.
Say there is 30M$ outstanding. If the effort to recover it winds up costing 8M$ then the company makes 22M$ of which some goes to bonuses for the recovery team, promotions, and higher salaries.
The question is how many of these steps did Medicare go through before it was shut down, and was it shut down because it didn't look good internally or was there external pressure.
Posted by: MonkeyBoy | September 12, 2007 5:44 PM
The fall of the dollar was inevitable. It is the only way to get the trade deficit down to size. The real problem was allowing the dollar to rise to the point that it made such a painful adjutsment necessary. This was the Clinton-Rubin high dollar policy. It felt good in the short-term (except for manufacturing workers), but just like tax cuts that lead to big budget deficits, it could not be sustained.
Posted by: san | April 8, 2008 1:56 AM