Tuesday, September 25, 2012

Obama Administration, Asleep at the Switch…

Yesterday various press outlets reported that the Administration warned hospitals and other medical providers about questionable Medicare billing tactics that could range from abusive to fraudulent.  But that’s not the real story – the real story is how the Administration was asleep at the switch for years, allowing these abusive practices to continue, even accelerate.  A study by the Center for Public Integrity published in the Washington Post more than a week ago, and highlighted in this space, noted that “thousands of doctors and other medical professionals have billed Medicare for increasingly complicated and costly treatments over the past decade, adding $11 billion or more to their fees – and signaling a possible rise in medical billing abuse.”

So what did the Administration do when this major Washington Post expose appeared, questioning $11 billion in Medicare spending as questionable, abusive, or even downright fraudulent?  Exactly nothing.  Only when a second, similar story appeared in the New York Times this weekend did Secretary Sebelius finally send a letter questioning provider billing practices, and promising vigilance on this issue – with “vigilance” hopefully meaning something, after her Department’s years of neglect.

The Administration has asked questions of Medicare providers about their billing practices, but the real questions belong to the Administration:

  1. Why did the Administration wait so long to take action – and how many billions of dollars in questionable transactions were completed because this Administration decided not to examine billing practices for potential abuse and fraud?
  2. How can the Administration implement the 2700 pages of Obamacare if they can’t even ensure that existing laws and practices within Medicare are being followed?  Conversely, was the Administration asleep at the switch when it comes to questionable billing practices because HHS is spending all its time, personnel, and resources implementing Obamacare, rather than watching over Medicare?
  3. How can President Obama and Secretary Sebelius claim Obamacare helps crack down on fraud, when they allowed $11 billion in questionable transactions to go unchallenged?  Given this record, perhaps the Administration would be better off outsourcing oversight of Medicare to the Center for Public Integrity and the New York Times.

One final note:  Three liberal advocates, including former OMB advisor Zeke Emanuel and former CMS Administrator Donald Berwick, penned an op-ed in this morning’s Wall Street Journal denouncing comprehensive Medicare reform, and claiming that government-run Medicare can do a better job containing costs because “the key to sustainable cost control lies in encouraging physicians and hospitals to focus on quality rather than quantity, and value rather than volume.”  These claims would have somewhat more credibility if they weren’t co-authored by someone who, in nearly two years at CMS, allowed transactions potentially bilking Medicare for billions to pass through undetected right under his nose.  Given that track record, Dr. Berwick is in absolutely no position to give lessons on how to “save” Medicare.  Instead the old proverb rings true:  Physician, heal thyself.