Although I am an Arc member of staff, I am writing this post as a US citizen.
There’s a very interesting article in the Dec/Jan issue of Fast Company magazine called “The $70 Billion Scam” (http://www.fastcompany.com/magazine/161/medical-fraud). It’s about Medicare fraud, which is rampant inMiami and is now spreading to other large cities in the country because it is so lucrative.
An expert on Medicare fraud is quoted as saying that, at a minimum, 10% of Medicare claims are fraudulent. The author of the article points out that credit card companies – where fraudulent activity hovers around 1% – would be forced to close their doors if they experienced this level of fraud.
It’s not that solutions don’t already exist… the credit card industry is miles ahead of the government in using tools for recognizing fraudulent activity. Even the Centers for Medicare and Medicaid Services (CMS) are exploring options, with a pilot ID card, in Indianapolis.
The Obama administration proposes trimming $248b from the Medicare budget over the next 10 years; that’s a lot of benefit for a lot of people that rely on a safety net. A 10% reduction in fraud – just 10% – would release $80b a year. A no brainer.
For many individuals with developmental disabilities and their families, Medicare is a lifeline. It makes my blood boil when I think about the amount of money that is hemorrhaging out of the system through fraud. When my blood boils, I do something to lower the temperature. In this case, I’ve written to my senator suggesting the government increase anti-fraud activity – instead of punishing the people that rely on Medicare and Medicaid by reducing their benefits and services, we need to plug the hole in the dam and divert those resources back to where they belong.
I believe that our legislators need to hear our concerns loud and clear – I hope you write to yours about what concerns you.
Ellia Ryan - Director of Development at The Arc of King County
Absolutely and what is even worse is the people who serve this very population participate in fraud. In reviewing Certified Residential Care Provider Cost Reports and Washignton State Auditor reports, I have much of this – millions of dollars being wasted which could be used to improve the safe, quality care for our population;
For instance, one group home as the owner listed as doing two jobs with the total hours she worked (and got paid for by the state) at about 9,900 (there are 8,700 hours in a year) and wages of $137,462.
Without oversight I think we will see more and more fraud. This is just on example and there are many more which are questionable and should be investigated. What I found extremely mind-boggling was that in response to one Audit report DSHS stated that they knew there was a problem (related to overpayments of employees, paying non-existant employees, double benefits for current employees and conitnued payments for benefits for employees who have not been in the department for years) but that they just couldn’t control some of that and that’s just the way it is.
Who believes this a a managment style of successful business? I don’t and maybe that’s one reason our state is in such a mess.