Health & Science

Latest Medicare Fraud Crackdown Could Have Political Implications

The latest nationwide crackdown on medicare fraud involved 91 doctors, nurses and others in seven cities, including Houston. KUHF Health and Science reporter Carrie Feibel has more on what happened and how this could play out politically in the upcoming election.


Medicare has become political fodder yet again, both because so many voting seniors depend on it and because it’s such a large part of the federal budget. 
In Wednesday night’s debate, President Obama made sure to mention that his administration is tackling the cost problem in multiple ways, including the prosecution of fraud.
“We went after medical fraud in Medicare and Medicaid very aggressively — more aggressively than ever before, and have saved tens of billions of dollars. Fifty billion dollars of waste taken out of the system.”
The day after the debate, the feds indicted 91 people, accusing them of falsely billing Medicare for $430 million dollars. 
In Houston, the president of Riverside General Hospital was arrested, along with his son and five others. 
Riverside is historic; it was once the Houston Negro Hospital – but now specializes in the treatment of mental illness and substance abuse. 
Vivian Ho is a health economist at Rice University’s Baker Institute. 
She says it’s hard to know for sure, but some studies estimate that up to 10 percent of Medicare spending is actually lost to fraud and abuse. 
So stopping that crime is quite important: 
“To that extent, ten percent savings would be wonderful in terms of trying to deal with the deficit we’re facing because we spend so much on Medicare. So when we’re talking about fraud, if we can address it effectively, it’s not a drop in the bucket, it’s actually a tremendous amount of savings that would make us all better off.”  
Ho says investigations of medical fraud slowed down after 9/11, when the government was more focused on terrorism. 
But investigations and arrests have picked up over the last two years. 
They often focus on organized crime rings that steal the identity of seniors and bill for services at non-existent clinics. 
Criminals also use home health care, ambulance services, and medical equipment to defraud the system. 
But Ho admits that even when the government publicizes a huge crackdown, it’s not always perceived as good news. 
“The other side effect of all this fraud is it leads to people being less confident that their taxpayer dollars are being spent well and they end up being less supportive of government provision of healthcare. They just become, I think on the margin this Medicare fraud can lead people to become more cynical about supporting the Medicare program.” 
Still, Ho says the answer is not giving up on Medicare but cracking down even more, especially using data mining and other digital tools. 
A report from the Health and Human Services Department indicates that for every dollar spent recently investigating medical fraud, the government recovers more than seven dollars.
From the KUHF Health and Science Desk, I’m Carrie Feibel.