Following the numbers – not always easy, even for journos

When I read the Strib article on home health care overbilling, I recalled last year’s 60 Minutes exposé of highly-organized health care fraud in Florida, and tried to check back to see what has been done to investigate, prosecute, and stop the fraud. The first article that turned up was a May 6 CBS I-Team report from Florida, charging that “government investigators say CMS still can’t accurately track improper Medicare payments.” That sounded important, but the article itself was confusing, referring to the 60 Minutes report, quoting President Obama in a context that was not clear, and referring to “a new bill” to attack fraud.

The I-Team reporter, who writes that he was part of the original 60 Minutes investigation, pointed to a “62-page performance audit” by the “General Accountability Office, the GAO,” which he says “follows the money trail of Medicare contractors that paid out about $310 Billion dollars in payments from 2004 to 2008.”

That sounded like a place to go for facts and figures, but the report’s text didn’t match the claims made in the article. From the name of the reporting agency (Government Accountability Office, not General Accountability Office) to the subject of the report – which is actually “transitioning claims administration to 19 new entities known as Medicare Administrative Contractors (MAC)” by October 1, 2011 – the article and the report did not match up. In fact, GAO-10-60 does not follow any money trails, nor does it directly address any investigation or tracking of health care fraud or Medicare fraud.

The CBS I-Team article said:

CBS4 I-Team has learned the agency that administers Medicare, called “CMS” still cannot say exactly how much, if any money has been saved by what’s passed so far as Medicare reform. …

The GAO says CMS has made quote “some progress” in monitoring and reducing fraud, waste and abuse” but that some of these new systems have also caused long delays in some Medicare payment cases that are legitimate.

Not exactly.

• The GAO report is concerned with an administrative change in contracting rules that was ordered back in 2003 — not “Medicare reform” as most readers would understand the term.

• The only reference to “fraud, waste and abuse” in the entire 62-page document is in the standard “To report fraud, waste and abuse in federal programs” phone number at the bottom of the final page.

• There’s no evaluation of the CMS progress in monitoring or reducing fraud, and no reference to “some progress,” despite the quotation marks in the CBS article.

When I contacted I-Team reporter Stephen Stock, he referred me to passages in the report such as this one on page 36:

Although CMS estimated that it would achieve savings from two sources—reduced spending on administrative functions and savings from the Medicare trust funds related to better claims review leading to reduced improper payments—the agency has provided information only on administrative savings, making the total amount of any savings and the extent to which they are due to contracting reform uncertain.

He wrote that “this was a follow-up to our investigation into Medicare fraud which included, in the government’s language, ‘improper payments.”

In a December 4 article, Stock had made similar allegations about “government” failure:

Only days after our initial investigation aired, Congress’ General Accountability Office (GAO) [sic] issued its own report. The report said the Centers for Medicare and Medicaid Services, or CMS, had either ignored or not taken sufficient action on 7 out of 9 recommendations to fix this broken system. In part the report reads “We found pervasive deficiencies in internal control…” which “…increase the risk of improper payments or waste.”

Again, there’s a problem: the report that is cited in the December 4 article does not deal with health care services fraud, which was the focus of the 60 Minutes report and is the big, money-sucking hole in the health care system. Instead, the GAO report cited in this article addressed contracts for administrative services:

CMS reported total obligations for CMS contracts in fiscal year 2008 were $3.6 billion. This amount includes obligations against contracts that process Medicare claims as well as obligations to other contractors such as those that operate the 1-800 Medicare help line, provide program management and consulting services, and support information technology.

Attacking the government is easy. Wading through the facts and figures and voluminous government reports is harder. But this is too important to get wrong.

For more on reporting on Medicare fraud and health care fraud, see By the Numbers: Figuring out health care fraud