How much Fraud, Waste and Abuse is there in the Social Security Administration (Part six) – Not much as over ten years’ worth of investigations have shown.
Think of the United States Government as a giant business. All businesses must account for their dollars to their owners and others. Because this is money that is being investigated and accounted for, the independent investigators that investigate businesses are accountants. Their investigations are called audits, again because it’s money we are talking about.
Inspectors General answer to the Congress. The Social Security Administration Office of the Inspector General has enormous, delegated responsibility to protect taxpayer dollars. The Inspector General accomplishes the mission by:
- conducting independent audits, evaluations, and investigations;
- searching for and reporting systemic weaknesses in SSA’s programs and operations; and
- providing recommendations for program, operations, and management improvements.
The mission given to Inspectors General by Congress to search out and destroy fraud waste and abuse has proceeded with a vengeance since 2010 with a series of Inspector General audits and other internal fact gathering processes.
Here are some of the highlights from these reports.
Medicare and Medicaid Fraud
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national
Health Care Fraud and Abuse Control Program under the joint direction of the Attorney General and the Secretary of Health and Human Services Inspector General.
According to the most recent Annual Report of the Attorney General and the Secretary, In 2023 more than $3.4 billion was recovered in combined Medicare and Medicaid fraud restitution. The exhaustive list of types of fraud committed against Medicare and Medicaid includes improper payments to Hospitals and Health Systems, Nursing Homes and Facilities, Pharmacies, Physician and Other Practitioners, Home Health and Managed Care Providers, Substance Use Treatment Centers, and the like.
Nowhere on the list is any type of fraud committed by those who are insured by Medicare and covered by Medicaid. The fraud and waste are due to improper billing for services by the healthcare industry itself.
That leaves the question of how cutting healthcare benefits to seniors and the disabled who need the healthcare in the first place solves the problem of improper billing by the physicians and hospitals and other healthcare providers who are enriching themselves with the money.
Fraud waste and abuse is a thin disguise for cutting the programs Congress has authorized.
If only it could be seen as such. We are being misdirected.
