Downsizing Blog

Another day brings another example of federal health care fraud. Today’s story comes from “the nation’s healthcare fraud capital” of Miami-Dade County. The government’s crack investigators realized it was fishy that a single county was accounting for more than half of Medicare’s total payments for the treatment of homebound patients with diabetes. Miami-Dade doesn’t even have Florida’s highest rate of diabetes.

That’s the title of a piece in Saturday’s New York Times. That welfare usage is up in a recession isn’t surprising, but if the stigma is truly fading it’s not a positive development. As a Cato essay on food subsidies states, “The [food stamp] program contributes to long-term dependence on government and produces various social pathologies as side effects.” Disturbingly, the USDA official who oversees the program is pleased:  

Official estimates put the amount of improper payments in federal subsidy programs at about $100 billion a year, with Medicare and Medicaid accounting for more than half. The actual loss to taxpayers is probably much higher.

The Obama administration and its allies in Congress want the federal government to expand its role in subsidizing health care. We are told that this expansion will restrain rising health care costs. But an OMB report yesterday that the government made $98 billion in improper payments last year – $55 billion of which came from Medicare and Medicaid – ought to raise suspicions about that claim. 

From the standpoint of Americans who prefer less government, one of the worst developments of the 20th century was the federal subsidization of state and local spending. The result has been bigger government at all levels. Medicaid represents the largest portion of federal money to the states. The states administer their own Medicaid programs, but the federal government picks up 50 to 83 percent of the tab depending on a state’s income. The estimated price tag of the federal share for fiscal year 2009 is $260 billion.

Policymakers considering the creation of a health insurance “public option,” or even an expansion of Medicare, should remember that government health programs already wear a bullseye when it comes to fraud and abuse. According to a report on CNN.com, organized crime has found a cash cow in Medicare and Medicaid.

The Washington Post reports on the curious case of David W. Wilmot, a D.C. lobbyist who also earns $300,000 a year as the head of a troubled nonprofit group that’s funded by Medicaid. D.C. officials have asked a judge to put two of the nonprofit’s group homes in receivership and halt all referrals to its eleven facilities because of “systemic” problems.

In 1798, President John Adams signed a law that required the owners of American ships to withhold 20 cents a month for each crewman’s pay and to forward the money to customs offices in various ports. Customs officers were required to forward the money to the secretary of the Treasury, who would use the money to pay the hospital bills of ailing sailors. The funding also supported a network of marine hospitals.

Sometimes it’s hard to figure out which is more infuriating for taxpayers: illegal fraud in a government program, or legal abuse of that program. The State of New York recently took $140 million in federal “stimulus” money and handed it out with no strings attached to people on welfare for the ostensible purpose of back-to-school needs.