Sun Editorial:

Stopping wasteful spending

GAO finds rampant Medicaid fraud tied to illicit distribution and use of drugs

Monday, Oct. 5, 2009 | 2:06 a.m.

The public owes a debt of gratitude to prosecutors across the country who have gained convictions against physicians who committed Medicaid fraud through illegal drug distribution. In many cases, the doctors contributed to drug abuse and their customers died as a consequence.

Some doctors even have contributed to criminal enterprises by selling drugs to friends who, in exchange for splitting profits with the physicians, sold the pills to third parties. That’s just pathetic.

This is all possible because the federal Centers for Medicare & Medicaid Services has done a poor job of assisting states in the fight against Medicaid fraud. That troubling conclusion was made in a report released Wednesday by the Government Accountability Office, the investigative arm of Congress, which also found that many states are ill-equipped to monitor fraud.

The GAO, in a study of some of the nation’s most populous states, uncovered 65,000 cases in 2006 and 2007 where Medicaid beneficiaries each obtained the same prescription drugs from at least six different doctors. The cost to Medicaid for those painkillers, sedatives and stimulants was $63 million.

Although the GAO said some beneficiaries could probably justify going to several doctors in the same medical group for drugs, it also found cases of individuals who obtained the same drug from more than 100 physicians.

The GAO also found more than 1,800 cases of drug prescriptions that were filled after the beneficiaries died, and more than 1,200 prescriptions that were “written” by doctors who had passed away.

To eliminate this waste and fraud, Congress should make sure the Medicaid agency follows up on GAO recommendations that states have effective fraud prevention systems.

This obviously would involve, for starters, making sure that actual living, breathing doctors are the ones writing prescriptions and that the beneficiaries, too, are still alive. Also, Medicaid payments should be denied to doctors or pharmacies that are barred from federal contracts or excluded from Medicaid programs, and beneficiaries should be prevented from obtaining unauthorized quantities of drugs through multiple doctors.

Anything less would be unacceptable.

Discussion: 7 comments so far…

By ckelly12

10/5/09 at 3:58 a.m.

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Besides being unconstitutional from the get-go (states' rights), Medicare has turned into a check-writing enterprise. Why? Because for the federal government to run anything other than the military, it is impossible to police in a nation this large. Sheer numbers overwhelm the system and that invites fraud.

So often proponents of the public option in health care point to UK or Canada as examples that work. First, many don't think that do, but consider the difference in size! The USA is 3x the size of the UK and 6x the size of Canada.

If Congress would pay attention to Americans, we want only three things passed until the budget is balanced and the deficit is reduced: 1) actively prosecute abuse and clean up the fraud in Medicare, 2) torte reform, and 3) open insurance inrollment across state lines.

NOTHING ELSE!

http://clearcloudycarol.blogspot.com/
By neiman1

10/5/09 at 6:05 a.m.

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We want to buy drugs from Canada where having limits on liability suits makes them cheaper yet we wont change our liability laws to make them cheaper here.

How much would all products be made cheaper if you couldn't sue a lawn mower manufacturer for sticking you hand in the blades?
By LarryVegas

10/5/09 at 11:50 a.m.

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Don't worry about any wasteful spending by the government once they get a single payer health system in place.
By jldour

10/5/09 at 12:19 p.m.

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Just watched an interview with Mike Leavitt, the former Sec. of Health. He tried to institute a competitive bid policy for things like scooters ($1000 to the general public, $4000 to medicare), respiratory pumps ($700 to purchase to the general public, $3000 rental per year to medicare). He said as soon as he put this policy into place the medical supply industry mobilized their lobbyists (pimps) and they got after members of congress (whores) and guess what happened. That's right, no competitive policy in place any more. It is absolutely outrageous. If the politicians are beholden to the lobbyists and are only worried about their next election, there will be no change that is meaningful. This is not a republican or democrat problem, it is business as usual in DC. Term limits is an idea whose time has come.
By KillerB

10/5/09 at 1:02 p.m.

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"...the federal Centers for Medicare & Medicaid Services has done a poor job of assisting states in the fight against Medicaid fraud."

Another part of federal government outed as not doing what it was set up to do. Like other recent outs by the Sun, one must ask why the federal government should be trusted with ANYTHING. Then consider the feds' grab for centralized power away from the states in complete violation of Constitutional limitations.

"Human wisdom has never devised a form of government so perfect that it may not be perverted to bad purposes. It is never conclusive to argue against the possession of certain powers from possible abuses of them. It is safe to say that if Congress should venture upon legislation manifestly dictated by selfish interests, it would receive quick rebuke at the hands of the people." -- U.S. Supreme Court in Downes v. Bidwell, (1901)
By seeingtruth

10/5/09 at 4:56 p.m.

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I suggest everyone to go to this site and read this report..

http://www.nrlc.org/HealthCareRationing/...
By LarryVegas

10/5/09 at 6:03 p.m.

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I can't believe that the Federal Government has done a poor job in the fight against Medicaid fraud.

Wait a minute... The Federal Government has also done a poor job in Medicare fraud.

But, I sure the Federal Government would do a great job in managing a complete takeover of the U.S. Health Care System...