A doctor is offering a second opinion on problems with waste,
fraud and abuse in government-run medical programs.
Lawrence R. Huntoon, MD, PhD, says politicians
who have promised more than taxpayers can afford often point to
those who provide medical care as the main source of waste, fraud
and abuse in Medicare and Medicaid. But he points to a report from the Department of Health and Human
Services (HHS) Office of Inspector General, saying it provides
conclusive evidence of overbilling fraud on a massive scale
committed by the government itself.
"The House Committee on Oversight and Government Reform found
that New York state overbilled the federal government by $15
billion over the past 20 years for Medicaid cost for
developmentally disabled patients," Dr. Huntoon reports. "[It]
turns out that the Centers for Medicare and Medicaid Services knew
all about this overbilling since 2007, yet they took no effective
action to stop it."
And as he explains, there are a number of reasons for that.
"The whole thing occurred because of the way that the government
set up the rate-setting methodology -- that is, the federal
government told New York state, based on waiver that was in 1986
and retroactive to 1984, which allowed the state-run developmental
care centers, to be paid on total reimbursable cost, as opposed to
actual costs," he details.
It turns out that the total reimbursable costs were 64 percent
more than the actual cost, resulting in the overpayment.
Dr. Huntoon adds that another factor involves a law passed in
2007 that essentially prohibited Health and Human Services from
lowering those maximum payments to Medicare providers.