Cleaning up Medicare

The surprising retreat of Columbia/HCA from home health care is merely the most visible sign of an industry about to undergo a major overhaul. Billions of taxpayer dollars already have been wasted through home health fraud and mismanagement; members of Congress seem to have caught on that this drain on federal resources can and should be stopped.

The nation’s health-care giant, Columbia, is planning to sell its its home health division as part of a larger shakeup of the corporation after some of its officers were accused by the government of abusing the Medicare system. Poor business practices in the industry, however, are not confined to the major players. A report by the Health and Human Services inspector general found violations at every level that account that help push the total Medicare fraud level up to as high as 14 percent of its budget, making fraud a $27 billion problem annually.

The Senate Subcommittee on Permanent Investigations, led by Sen. Susan Collins, held hearings on this issue earlier this summer. It revealed widespread misuse of Medicare money that was eroding public support for this important program — some agencies billed for care never given, others offered multiple types of care at a single visit but charged as if each was a separate visit, other billed for outrageous expenses, patients claimed to meet the measure for being homebound when, in fact, they did not. The variety of charges are coming to light so quickly that the American Hospital Assiciation recently asked for a six-month moratorium on investigations to give hospitals a chance to double check their paperwork.

Especially at a time when Medicare faces cuts from Congress or higher payments by participants, the money stolen from the program threatens to rob some people of basic care. Sen. Bob Graham of Florida this year added more than a dozen provisions to prevent fraud and to increase enforcement, but a law already on the books could be expanded and used to fight Medicare waste.

The False Claims Act allows people who have evidence of fraud to sue on behalf of the government and to share with their lawyers from 15 to 30 percent of the money recovered. The Civil War-era act, also known as the Lincoln Law, was revived by the Reagan administration to reduce federal waste and is needed now to protect Medicare. Three years ago, the Justice Department gave just 40 of these cases to HHS inspectors; last year, they passed along 200.

The ways to rip off Medicare are nearly endless. Congress can’t battle the crooks on every issue, but it can offer tough, broad guidelines for cleaning up the system and ensure that incentives are in place to keep Medicare honest.