May 26, 2009

Editorial: Stop the Abuse

Stolen Medicare identification numbers, falsified prescriptions, kickbacks to patients. Bills for unnecessary HIV infusion therapy, fake care of diabetic patients and medical equipment and inhalation drugs that never got to patients because doctors never prescribed them.

Taxpayers pay an estimated $60 billion a year for scam artists to get rich off the nation's healthcare programs for the elderly, disabled or poor, with South Florida at the epicenter of fraud. Miami prosecutors have charged about 800 Medicare offenders since 2005, uncovering $2 billion in false claims.

This abuse of the public trust can't go on. Certainly not if President Barack Obama expects Americans to back reforms that would make healthcare affordable and accessible to all Americans, including the 40 million-plus now uninsured.

So the administration's new mission to combat scammers is welcome news. It has committed to step up enforcement in the Medicare program by 50 percent, adding $311 million in fiscal 2010. It would clamp down on schemes from Miami to Los Angeles, establishing new federal strike forces in Detroit and Houston, too -- the top four cities for fraud. Justice and the Department of Health and Human Services will work closely to share intelligence and check billings -- not months and years after the fraud has occurred and criminals have left the country, but, rather, as those bills are filed for payment.

That should be just the beginning if voters are to trust the president and Congress to deliver healthcare reform that's neither wasteful nor invites fraud.

For too long the scammers have beaten a broken honor system. Despite the good work of South Florida's U.S. Attorney's Office to catch get-rich-quick criminals the past two years, new abusers keep popping up because the fundamental problem remains: Without aggressive front-end mechanisms to prevent and detect fraud, criminals will keep finding ways to milk the system while hapless regulators play catch-up.

Several smart fraud-fighting initiatives have been proposed in Congress in an effort to prevent abuse. Among them:

• The Seniors and Taxpayers Obligation Protection, or STOP, Act, would end the use of Social Security numbers for seniors' Medicare cards, reducing identity theft.

Pushed by Florida Sens. Mel Martinez and Bill Nelson, STOP also would require doctors to check monthly claims the government receives to ensure the care has been provided.

It requires federal agencies to share information and conduct criminal background checks and more aggressive inspections of medical suppliers' offices to ensure they actually have equipment and aren't operating out of a post-office box, as Miami Herald reporter Jay Weaver found in his extensive reports last year.

• The Medicaid Accountability through Transparency, or MAT, Act would combat fraud in the program that serves the poor by requiring Health and Human Services to disclose payment information in a Website open to the public.

Modeled after a successful program in South Carolina, it's a taxpayer-right-to-know call for transparency. The MAT information would protect patients' identities even as it helps policy makers, academics and the public track Medicaid payments and trends.

States, which made $32.7 billion in improper Medicaid payments in fiscal 2007 alone, would face a $25,000 a day penalty if they do not fully disclose where their share of federal dollars is being spent.

Congress should move swiftly on these fraud-fighting tools before they tackle universal healthcare. Taxpayers deserve no less.