If, as many Americans believe, the current system of federal funding for healthcare is unsustainable, alarming allegations out of South Florida are a big, costly part of the reason why.
Unfortunately, fraud and abuse in the healthcare industry are longstanding here. More troubling is that too many in charge of overseeing how these taxpayer dollars are spent are falling down on the job, allowing funds to be misappropriated — stolen, basically — but also putting patients’ health and well-being at risk.
Earlier this month The Miami Herald reported that the long-time director of the Miami Beach Community Health Center, Kathryn Abbate, allegedly stole almost $7 million from the center. Given that the center’s funding comes from federal grants, that’s $7 million of our money.
And Ms. Abbate, who’s been fired, had help: According the center’s board, Diego Martinez, the center’s chief compliance officer — a laughable title in this case — cashed thousands of dollars in checks for his boss. Mr. Martinez has resigned. So have the chief financial officer and the human resources director, both of whom, the board determined, “facilitated” the alleged embezzlement. And get this: the CFO admits that he knew of Abbate’s activities but didn’t alert the board. That’s a shameful dereliction of duty.
Ms. Abbate’s alleged thievery dates back to 2008. Who knows how many patients could have received care for that $7 million? However, there is evidence of an even more egregious money grab at hospitals that are part of the HCA powerhouse. As reported in The New York Times, the chain discovered, after a whistleblower complained, that some of its cardiologists were performing unnecessary heart procedures. This, of course, drove up costs — and profits. Doctors were unable to justify many of the procedures performed. HCA is the nation’s largest hospital chain, with 163 facilities. Florida, it seems needless to say, was Ground Zero for these offenses. The former Cedars Medical Center was among those involved.
HCA was mum as to whether it has contacted Medicare, Medicaid or private insurers about its findings. Nor has it said whether patients who underwent procedures needlessly were alerted.
With the sort of evidence unearthed, why should it be up to the violator to contact the authorities to say “my bad?” Rather, the feds should be all over such companies, doggedly pursuing reimbursement — and civil or criminal charges if any laws were broken.
These types of cases undercut the beneficial work of the federal programs that have kept seniors, children and some of the neediest among us in good health.
When it comes to Medicare, specifically, South Florida is the fraud capital of the nation. The feds say that fraud sucks up to $90 billion out of the system, and that Miami accounts for about $3 billion of that estimated amount.
The Affordable Care Act contains tougher tools for fighting fraud. It provides new technology to scrutinize Medicare payments at a timelier rate and flag suspicious patterns. But it’s imperative that there be more-comprehensive background checks to block the bad actors before they get their hands on our money.
Better policing is not the federal government’s role alone. The Abbate case is a wake-up call for local boards, which must be diligent in their oversight and toughen policies regarding who can sign off on what’s spent and on what. Admittedly, that’s difficult if the CFO is in on the scheme. Still, anything less is unacceptable.