Pork Under Attack as Pol Chews the Fat

 

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It can happen, that politicians turn whistleblower. Politicians, even when they are serious about government waste, may still look the other way when bacon is passed out in their own districts. But not all senators have reputations for flinching in the face of governmental waste. Farm-state Senator Charles “Chuck” Grassley has earned a reputation for earnest, even zealous, pursuit of out-of-control trough mentality.

Concerns about changes to the national health care system have prompted Grassley’s latest tilt against federal windmills.

Though Grassley’s attack on ‘Obamacare’s’ Doctor Daniel Berwick has been attacked as ‘opportunistic’ by opponents, Grassley’s case against Berman’s new domain is nothing novel. Part of the expected problems in health reform accountability is the sheer size of the existing system…and the transition of this already massive system into something even bigger. Grassley labels the existing problems: “inadequate management and oversight of contractors by the Centers for Medicare and Medicaid Services (CMS). These contractors include Medicare Administrative Contractors (MACs), Program Safeguard Contractors (PSCs), which are being transitioned to Zone Program Integrity Contractors (ZPICs), and Quality Improvement Organizations (QIOs).” Grassley then goes on to note that problems are virtually certain to be endemic in this transition.

In a scathing report, released in October, 2010, Grassley hearkens back to 2004 to trace early accountability problems. In building his case, however, Grassley does not have to rely on political allegiances. A federal court took five years – from 2004 to 2009 —  to investigate claims of massive misspending, totaling almost one quarter of a billion dollars, in a single Medicare fraud case.

Penalties, fines and interests eventually led to a $450,000,000 judgment.

The keys to the case were held by the 49 subcontractors, who helped build a pattern of corruption by the primary contractor, All-Med. Medicare was put in the position of  attempting to defend itself as All-Med’s virtual surrogate. Essentially, Medicare’s position was “it’s not our job” to monitor for illegality. The federal district court, however, emphatically slapped down the proposition of innocent government incompetence:

“This Court observes that the wealth and effect of the overwhelming evidence of the fraudulent submission of claims to Medicare should have been equally apparent to Palmetto GBA as it was to this Court, if not more so, given Palmetto GBA’s obligations as fiscal agent in authorizing millions of dollars in payment. It is unclear why Palmetto GBA is not a subject of the Government’s investigation into criminal wrongdoing, in light of the overwhelming evidence covering months of losses in the millions.”

One sound result of the court’s ruling, and Grassley’s championing of toothy senate oversight, is a vindication for government employees, who feel becoming whistleblowers is a valid way to stop waste. This is the very basis for the False Claims Act, which has been decsirbed as ‘deputizing’ private citizens with power to pursue wrongdoing. White, J. “False Claims Act: Deputizing the Public to Combat Corporate Fraud” Paper presented at the annual meeting of the The Law and Society, J.W. Marriott Resort, Las Vegas, NV <Not Available>. 2009-05-25.

Watchdogs in the health and human services field are aware of a dirty little secret. Despite historic attention to the details of the nascent national health acre program, very few Americans are aware — and despite Grassley’s relentless campaign of encouraging whistle blowing — that the government already pays more than half of all medical reimbursables and insurance costs. Nor is health acre waste likely to be solved by individual accounting practices. Grassley has cited evidence from an Office of the Inspector General’s report, demonstrating waste and fraud may account for a ‘built in’ element of the total system. I.e., almost 40% of waste occurs in the hospital management system, rather than individual criminal activity, This may well suggest a lone whistle blowing Senator may be whistling in the face of a financial hurricane.According to the OIG, 40 percent of the improper payments were made to inpatient hospitals.

Improper Payments by Type of Provider

 

Type of Provider Improper  Payments Percentage of  Improper  Payments
Inpatient hospitals $1,912,323 40%
Durable medical equipment suppliers 1,184,505 25%
Hospital outpatient departments 584,840 12%
Physicians 313,469 7%
Skilled nursing facilities 260,381 6%
Home health agencies 185,498 4%
Subtotal $4,441,016 94%
All other types of providers 279,416 6%
Total $4,720,432 100%

Source:

“Grassley wants answers from Berwick, Sebelius on Medicare fraud”  http://www.massdevice.com/news/grassley-wants-answers-berwick-sebelius-medicare-fraud

 

 
 
 

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