Tuesday, August 27, 2013

ObamaCare  Fraud Formula Flawed

I cannot give you the formula for success, but I can give you the formula for failure - which is"Try to please everybody.

Herbert Bayard Swope (1882- 1951), American Journalist, 3-Time Pulitzer prize winner

The IRS's new fraud prevention program, planned for use with Obamacare, has been plagued with implementation problems, according to a Treasury Inspector General for Tax Administration report.
ObamaCare Fraud Prevention Program Plagued with Implementation Problems,” Washington Free Beacon, August 27, 2013

People ask me what I worry about with Obamacare.
I worry but two aspects of Obamacare.implemention.
·         I worry about generalized system failure because of Obama’s desire to please all of the people in health system. In a democracy,  with its various population segments and political factions,  this is impossible.  You cannot please all of the people all of the time – conservatives,  liberals, libertarians,  believers, agnostics, atheists, secularists, capitalists,  socialists, and in health care, those who believe in coordination and competition (K. Baicher and H. Levy, “Coordination versus Competition in Health Care Reform,  New England Journal of Medicine, August 29, 2013).  

This task is complicated by the complexity o Obamacare – a collection of mandates, public insurance expansions, and regulations that affect different groups of Americans in different ways, at different times.  Try to explain these differences and the  convoluted morass to a skeptical American public.There are always two sides to any health reform policy formula ingredient -  Accountable Care Organizations, bundled payments, quality reporting, price transparency, pay for performance , electronic medical records, or high deductible and consumer-directed health plans.  All of these policies require computer competence,  security and privacy safeguards, and protection against hackers and identity thieves. 

·         I worry about the electronic competence of the Administration and that of the  various states health exchanges.      The Obama administration assures us that everything is on go and that every major government program – Social Security and Medicare and others – have experienced hitches, glitches, and bumps in the road – and so will Obamacare.  But Obamacare is not Medicare.  It has a much larger scope, involves multiple population groups,  has different eligibility requirements,  diffenent time entries of mandates and regulations, and is much more partisan because it poisoned the political well by passing it without a single Republican vote.   Furthermore,  it must create a computer “hub” that integrates computer programs from seven different federal agencies,  It even now  says it may determine eligibility by taking the word of those who might be eligible for subsidies without electronically verifying their information.   It must develop and run computer programs in 34 states who have opted out of Medicaid expansion and let the federal government take over.  And finally, the government is on a tight schedule to get its various programs ready for prime time, and it has already not met deadlines for 42 of 83 Obamacare provisions. This is the formula for massive fraud and abuse.

Washington has shown little competence in stamping out Medicaid-Medicaid fraud.   Fraud consumes 15% of the $1 billion CMS budget. As Peter Drucker observed, “The best we get from government in the welfare states is competent mediocrity. What is impressive is the administrative incompetence.”  Finally,  evidence is mounting that government control of computer technologies is out of hand,  as seen in abuses and leaks of the National Surveillance Agency, and the Chinese hacking into our corporate and government systems.

As Alfred E, Newman said in Mad Magazine, “What, Me Worry?”  You bet I do. I worry about the competence of the Obama  administration to enforce the employer mandate,  verify eligibility for insurance subsidies. require employer-provided policies to cap employees' out-of-pocket costs, and establish the computer systems needed to make Obamacare a workable reality.

Tweet: Ingredients of a CMS failure to control Obamacare fraud are all there, and its computer programs are not yet ready for prime time.






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