Declare war on Medicare fraud, not seniors

As Congress wrangles over the debt ceiling, the federal budget, and the future of entitlement programs, it's clear that the nearly $500 billion spent each year on Medicare will remain a topic of great interest. 

And it should be: Medicare, which provides health coverage for elderly and disabled Americans, is second only to Social Security in its share of the federal budget. As it figures out what to do with Medicare, however, Congress needs to take a close look at the level of fraud in the system and focus on reducing it before asking seniors who have paid into the system their entire lives to accept poorly conceived benefit reductions or co-pays.  Congress, in short, should declare war on Medicare fraudsters, not the seniors that benefit from the program.

It goes without saying that Medicare fraud costs the country a lot. The National Health Care Anti-fraud Association (NHCAA) estimates that $68 billion is lost to health care fraud annually. If Congress doesn't begin to take this problem more seriously, the total cost over a decade could easily reach more than $300 billion. 

And the acts committed are not harmless errors. In one recent case involving a chain of Florida mental health clinics, prosecutors allege that managers and doctors intentionally misdiagnosed patients with Alzheimer's disease so they could charge more to Medicare. The total cost of the fraud to taxpayers from this small group of alleged criminals: over $200 million. The tools to fight these crimes -- better information systems, mandatory compliance programs, effective background checks and stiffer penalties -- all exist. And it's worth spending more to improve them: The Department of Health and Human Services, indeed, finds that every $1.00 spent on increased fraud prevention efforts recovers $1.55 for taxpayers. 

While it's not possible to eliminate all fraud from Medicare, it's only fair that fraud be the federal government's first priority, particularly since the alternatives for saving money will undoubtedly harm seniors. Some, like a new board to oversee payments and cut them with little oversight from Congress, are simply high-handed, badly designed bureaucracy. Others -- and proposals to cut billions from the federal budget for home-based health care are a good example -- have the potential to cost far more than they'll save.

Programs to help seniors remain healthy in their homes, largely by having home health aides visit them on a regular basis, cost a great deal less than the $5,000-per-month or more tab for typical nursing home care. Because these health care professionals also see seniors much more often than doctors or nurses ever could, they can play a huge role in treating the chronic conditions like cancer, heart disease, and diabetes that afflict 96 percent of the Medicare population. By treating these conditions on an ongoing basis, Medicare also saves billions in hospitalization costs. 

Blanket cuts or changes to Medicare amount to an inopportune political and economic war on seniors. Even in a time of significant budgetary challenges, this is simply unwarranted. Rather than a traditional approach, Congress should first focus its efforts on specific instances of Medicare fraud. Without question, that's where waste -- and a lot of money -- resides.

John Breaux is a former Democratic senator from Louisiana and served as co-chairman of the National Bipartisan Commission on the Future of Medicare. He is currently senior counsel at Patton Boggs.

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