Medicare fraud stories ignore larger issues of reform

The problem is well-established; what to do about it is not

This has been a summer for Medicare fraud stories. In the past week alone, there were stories from The Wall Street Journal, The New York Times, and The Washington Post.

The Journal piece explained how Medicare’s claims database “reveals that some alleged bad actors have been in the Medicare system for years.” The story centered around one Dr. Robert Glazer, who is scheduled to go on trial in February. The Justice Department has charged him with writing prescriptions and certifications that resulted in $33 million in fraudulent Medicare claims.

The Times examined the internal obstacles to policing fraudsters at the Centers for Medicaid and Medicare Services, the agency that oversees the programs. Outside contractors are poorly managed, rife with conflicts of interest, and an “overburdened appeals process” has “largely stopped the recovery efforts,” the paper reports.

The Washington Post, meanwhile, took on fraud in the purchase of motorized wheelchairs, long a target of Medicare-scam investigations. The Post reported that the government knew how the wheelchair scheme worked in 1998, but it took 15 years for officials to curb the practice.

These are important stories and it’s hard to find fault with them, given that fraud accounts for nearly 10 percent of Medicare’s annual spending. But they all reinforce the same, familiar point: The government is losing the war against fraudsters and scam artists hell-bent on fleecing the agency and the taxpayers that fund it.

I felt like I had read those stories before. It’s a point I made a few months ago, when I wrote about ProPublica’s reporting on doctors with unusual billing patterns, the outliers. It was a good initial effort to dissect the data on physician billings, but as I noted then, there is more to these stories than spotlighting a few rotten apples. The entire Medicare barrel is rotten, and that’s a story that is much more important to the public.

It’s also a story that is much harder to dig into than simply reiterating the fact that fraud continues to be a big problem. The Center for Public Integrity got closer to the mark with its investigation earlier this summer of overbilling by Medicare Advantage (MA) plans. Senior reporter Fred Schulte and his team made the larger point that MA plans were supposed to save the government money but have done just the opposite, largely for political reasons. They showed the hypocrisy of Democratic lawmakers who once railed against overbilling in MA plans, but later helped kill proposed reductions in what the program pays to providers that were intended to address the overbilling problem.

In June, Paul Kleyman, who runs the Ethnic Elders Newsbeat at New America Media, published a scathing critique of a fraud story published in mid-June by The Huffington Post. In “How Dying Became A Multibillion-Dollar Industry,” HuffPo explored the increasingly for-profit hospice industry using court records, inspection reports, and other sources to document poor care. While the piece did provide interesting insights about how the hospice business works, Kleyman argued that it missed a much bigger point: How do we get beyond what he called the “house-of-horrors revelations,” the same journalistic dilemma that has been niggling me.

The HuffPo piece read like all those nursing-home exposés that journalists have done over the years (me included)—infrequent inspections, the creep to for-profit care, not enough staff, patients dying needlessly, etc. And despite all the fine reporting on nursing homes, the industry never seems to change. Why is that? That question went unanswered in the 7,000-word HuffPo article. For Kleyman, the piece failed to explore deeper issues like how to move the national conversation “from terminal hospital care to palliative or pre-hospice coordinated care,” one of the few models designed to deliver appropriate treatment that includes consultation with a healthcare team, the family, and patients.

Such larger questions need to be examined by journalists, in addition to the surface stuff about fraud and inspection reports. They need to delve into systemic issues that go beyond noting that Dr. X in Paducah, KY, may be a crook. Does the reporting challenge us in some way? Does it advance the conversation? Kleyman’s point was that the hospice story is not just about poor care and padded bills, it’s about what we want at the end of life and how healthcare dollars should be spent. Schulte’s piece was not just about greedy insurance companies but about political hypocrisy that allows the insurers to get away with their questionable practices. When we weave in the larger ideas about what reform might actually look like, we serve our audiences better and maybe—maybe—nudge the conversation toward actual change.

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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR's healthcare desk, which is part of our United States Project on the coverage of politics and policy. She also blogs for Health News Review. Follow her on Twitter @Trudy_Lieberman.