Now Here's A Bad Idea: Government Decreases Funding to Fight Medicare Fraud

 

Budget cuts are making healthcare whistleblowers more important than ever. According to the Department of Health and Human Services Office of Inspector General, thanks to cuts in the HHS budget, Medicare and Medicaid are about to have even fewer resources to fight fraud and abuse.

The Center for Public Integrity obtained internal documents from HHS-OIG that discuss the effects budget cuts are about to have on Medicare's ability to defend itself against fraud in the medical field -- and the outlook is grim. In all, OIG is losing 400 employees - a full 20% of its staff - as a result of the cuts.

Now that is a short-sighted plan. I don't know whether Congress or HHS is deciding where to place the cuts, but it is a huge mistake to cut funding from the branch of the agency devoted to getting money back in to Medicare and Medicaid coffers. As a whistleblower attorney, I can attest that there are brave men and women willing to risk their jobs to try to stop fraud. But these whistleblowers can address only a small fraction of the fraud.

As I explained in an earlier legal blog post, Government Recovers $4.9 Billion Thanks to False Claims Act, last year whistleblowers helped the Government recover $4.9 billion, and 3.3 billion of that was just for fraud in the healthcare field. But the Government estimates that Medicare is losing more than $60 billion to fraud every year. With those sorts of numbers, the Government simply cannot afford to shut down a program designed to bring dollars back into taxpayer coffers.

If the Government gives up fighting fraud, it not only will lose money, it also will embolden fraudsters who know they are very likely to get away with what they are doing.

A Harvard professor is predicting dire problems could result from the cuts to OIG funding. Malcolm Sparrow is warning that the Government needs to "stay ahead" of the cheaters, "Otherwise three years from now we will be saying how could we not have predicted this mess?"

OIG is worried, too. In an internal memo, an OIG official admitted: "As OIG's budget resources decline, so do our enforcement and oversight activities." And the cuts could not come at a worse time, as the government prepares to ramp up its spending in the health care arena. The agency conceded that it "will not be able to keep pace" with the coming expansion.

Whistleblowers who have inside information about fraud will become increasingly important as OIG's ability to fight fraud decreases. https://askcompetentlawyer.com/medicare-medicaid-fraud/ The sheer amount of fraud in the healthcare arena was already overwhelming for OIG. Now, with their staff and budget cut drastically, they will be less able to detect fraud on their own or pursue fraud.

The False Claims Act was strengthened in 2009 and 2010, fortunately just in time to encourage whistleblowers to step into the breach being created by the lack of agency funding to pursue fraud. A whistleblower who tells the Government about fraud can receive between 15% and 30% of the amount that the Government recovers. The Government is protected because the Government does not have to pay the whistleblower anything unless the whistleblower's suit actually collects money for the Government.

With the Government ceding more of the ground on fighting fraud, we can only hope the changes are enough to convince whistleblowers to come forward, so that we can stop hemorrhaging our nation's healthcare dollars.