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.