Obama Promises Healthcare Reform, But What Will Stop the Fraud?

In his weekly youtube address, the President acknowledged that the U.S. currently spends 50% more per person on healthcare than any other country in the world while fewer and fewer of her citizens get the care that they need. He also acknowledged that “Medicare and Medicaid pose one of the greatest threats to our federal deficit.” Acknowledging the problem is the first step to a solution, and the President is to be commended for that. But arguably the largest part of the problem lies with something that the President only hinted at: the massive, unapologetic fraud that plagues the U.S. healthcare system. The President danced around this problem with phrases like “rooting out waste” and “unnecessary spending” and promises to “make drug makers pay their fair share” and calling on doctors and hospitals to cease “unnecessary treatments and tests” — but he didn’t call these practices what they are: fraud.

In just over a month, this law blog has chronicled more than twelve major national healthcare fraud investigations, civil settlements, and criminal convictions: that’s more than three national healthcare frauds discovered per week (to say nothing of qui tam cases that are currently under seal and the untold fraud that goes undiscovered). At roughly the same time that the President was taking the oath of office, Frohsin & Barger was announcing that it had settled civil allegations of the largest Medicare Hospice fraud in the country’s history, recovering nearly $25 million of fraudulent charges related to perhaps the most sacred of healthcare service, palliative care for the dying. Since that time, we have only seen similar fraud increase dramatically. If fraud can pervasively invade the care for the dying, then there is no where it can’t go.

Until we tackle head-on the fraud pandemic, then we have no hope of salvaging our healthcare system. FraudBlawg applauds the President for acknowledging that the U.S. healthcare system is broken, admires his fearlessness in trying to fix it, and appreciates his promise to “insist upon fiscal responsibility.” But taking responsibility means rooting out the greed, corruption, and fraud that is now the status quo in the U.S. healthcare industry. Cutting costs will simply motivate more insidious fraud, and — conversely — throwing more money into the system will simply make the fraud easier to perpetrate and will motivate more unscrupulous people to jump into the game. While there is no easy solution, any attempt at healthcare reform must begin by making a priority of and allocating more resources to fighting healthcare fraud and taking a relentless and unforgiving stand against those who have and would cheat the taxpayers and defraud the federal and state healthcare systems.  

Some important strides have been made thus far under the Obama administration — including the bi-partisan support and passage of the Fraud Enforcement Recovery Act and the newly-assigned combined HSS and DoJ Health Care Fraud Prevention and Enforcement Action Team (HEAT) — but we still have a long way to go before the word “reform” is anything more than a buzz word in a stump speech.


To report healthcare fraud and government waste and abuse, contact Frohsin & Barger.