How much fraud is there in the system? I don’t know the answer, but I am pretty confident that policymakers tend to mischaracterize the scope of fraud. For example, the Washington Examiner quoted Vice President Vance:
“The fraud is right there for everybody to see. We closed down 800 fraudulent hospice centers. If you’re running a business and the federal government closes down your main source of revenue, do you write a letter? Do you make a phone call? Seven-hundred and eighty of those we’ve closed down, we haven’t even heard a single thing from anybody. That’s how bad the fraud is.”
I am certain that there are some hospices that received payment suspensions that didn’t respond. There are certainly fraudulent entities. It is possible that 780 entities failed to respond. I have no idea. But I do not believe that every single entity that was closed failed to respond. I know that in part because I know of a hospice that was thrown out of Medicare and has appealed.
That particular action stemmed from an issue with the 855 enrollment form. I don’t know that this hospice was one of the entities the Vice President was referencing. But I am very suspicious of the idea that not a single hospice challenged a shutdown.
I think it is going to be important for each one of us to reach out to our friends and family outside the healthcare industry and help them understand that when they see headlines about the percentage of healthcare dollars or other benefits that are spent “fraudulently,” the number is often more political than scientific.
When a patient gets a service they need and there is just a missing signature or element of documentation, or when an organization misses a revalidation letter or fails to update an 855, it may reflect an administrative error, but it is not “fraud” and it is not wasteful spending.
My concern is very much bipartisan. In the state of Minnesota, I am watching the Department of Human Services suspend payments without offering any explanation of why the action is occurring. In some instances, months or even years after the suspension, the Department has reversed course without ever offering any explanation for the action.
In some cases, this reversal happens after the organization was forced into bankruptcy by the state’s actions.
Is there fraud in the system? Of course. Should we try to address it? Absolutely. But just as the American criminal law process has worked to try to ensure that no guilty people are imprisoned, it seems that the civil process should prevent innocent healthcare organizations from being destroyed.
When we suspend payments first and ask questions later, it is a certainty that innocent healthcare entities will be bankrupted.
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