Medicare’s high noon

The Medicare posses were rounded up in Washington and Seattle, New York and Los Angeles, Chicago and Honolulu. They were off to fight fraud, and the federal government was telling these senior citizens right where to find it: Doctors and hospitals, the Clinton administration reported last winter, were ripping off the Medicare system and it was up to patients to stop them.

Or maybe they weren’t. After Health Secretary Donna Shalala, Attorney General Janet Reno and FBI Director Louis Freeh met with a dozen citizen groups to teach them how to detect fraud in their bills from doctors and hospitals, a new conclusion from the General Accounting Office strongly suggests the posse was headed in the wrong direction. At the very least, these Medicare sheriffs owe the medical establishment an apology.

The real culprits turn out to be the people in the companies that pay the Medicare benefits. These contractors, according to the GAO, were found to have altered documents, hidden files, backdated records and ignored some of the basic safeguards of bookkeeping to keep the system honest. In one case, a contractor tossed out thousands of claims to reduce the backlog of work; in another, one turned off its telephones when it found it could not answer customers’ calls in the allowed amount of time. Eight companies have so far paid $275 million to settle fraud charges.

These instances of theft and pathetic service would be simply one more story about a bureaucracy grown too big for its own good if federal crusaders had not so eagerly attacked doctors and hospital administrators just six months ago. Not content with accusing hospital administrators and doctors of stealing from the system, federal officials held “fraud fighter rallies,” urged seniors to “join the fight and help stop Medicare cheats from stealing your tax dollars,” and listed an 800 number to tattle on docs. They did this even as the American Medical Association said this type of rhetoric harmed the physician-patient relationship.

So for whatever harm has been done, for however much time and effort have been lost in the pursuit of the innocent and for the misguided zeal of the federal government, an apology is a good place to start. Followed immediately by job reassignment.