MEDICARE FRAUD

A government crackdown on Medicare and Medicaid fraud has worked wonders. There are plans to expand this project to every state in the nation, and this is one federal government program that needs to be bigger.

The one-year pilot program targeted five states: New York, Florida, Illinois, Texas and California. These states account for 38.5 percent of Medicaid beneficiaries and 34 percent of all Medicare recipients. They were a practical place to start.

The crackdown recovered $42.3 million, an impressive return of $10 for every $1 spent. That is the kind of government efficiency taxpayers deserve. The focus of the program has been on home-health agencies, nursing homes and medical-equipment suppliers.

Some of the fraud uncovered was downright preposterous. For example, one woman was invited to a get-acquainted coffee shortly after she entered a new nursing home. When her son was going through her bills, he noticed she had been charged for group therapy through Medicare.

Most of the cases involved totally inappropriate charges or gross abuses -- not borderline calls by health providers.

Of the 272 Medicare and Medicaid cases under investigation, 244 of these were opened as a result of this pilot program. That is an impressive statistic, which underscores the workability of this program. Those convicted of the fraud have been ordered to pay restitution and fines, which have been deposited in the Medicare Trust Fund and the U.S. Treasury. Tough treatment of these lawbreakers also sends a message to others.

There are estimates that this anti-fraud enforcement unit could save taxpayers $3.5 billion over seven years. That is no small change.

If the fraud were reduced, perhaps that would leave more dollars to appropriately reimburse hospitals, physicians and other providers who are towing the line and living within Medicare and Medicaid guidelines. Living within the guidelines typically means writing off considerable sums of money.

As the program expands, efforts can be made to keep the focus on enforcement and not on administration. Just because a program grows doesn't mean the efficiency and high return rate must perish.

This is a program that has worked despite the pitfalls of big government. Let's expand it to all states, but keep it focused on the job of saving money, not spending it.