Fraudulent and abusive calculations of fraud and abuse
Center on Budget and Policy Priorities
September 2, 2003
Reducing Waste, Fraud, and Abuse One Percent Of What? Double-Counting and Other Budget Committee Mistakes Will Require Some Committees to Cut Entitlement Programs More than One Percent
By Richard Kogan
Today (September 2, 2003), House and Senate Committees are scheduled to
submit recommendations on how to reduce “waste, fraud, and abuse” in federal
“mandatory,” or entitlement, programs. In May, the House and Senate Budget
Committees directed 12 Senate committees and 15 House committees to find
ways to reduce entitlement programs; the Budget Committees issued dollar
targets for each of these committees, supposedly equal to one percent of the
total entitlement spending in each committee’s jurisdiction. The Budget
Committees’ calculations were flawed, however, in major and minor ways.
As a result, most committees are required to find savings that represent
substantially more than one percent of the entitlement spending under their
jurisdiction, and a few are required to find savings of less than one percent.
The Budget Committees’ largest error was to double-count the cost of certain
“trust fund” programs. Double-counting makes these programs look costlier
than they really are, and so makes the savings targets for committees with
jurisdiction over these programs higher than one percent. The Budget Committees double-counted the cost of all programs that have trust funds
into which the U.S. Treasury transfers money, with the trust fund then using
the transferred funds to make payments to (or on behalf of) program beneficiaries. Programs with such a funding structure include the military
retirement program, the civil service retirement program, and Part B of
Medicare (the Supplemental Medical Insurance program, which pays for
visits to physicians, rather than hospital bills).
This is double-counting, and is scrupulously avoided by CBO and OMB.In total, double-counting of this nature by the Budget Committees produces ten-year savings targets that are $24 billion too high.
The Budget Committees also erred with regard to programs where the federal
government acts as an agent in “passing through” to other entities certain
funds that it collects for specified purposes… When a budget account is not really a government “spending program” but essentially is a pass-through for other transactions, there is no possibility of reducing the costs by one percent.
http://www.cbpp.org/9-2-03bud.htm
Comment: A major problem with programs of social insurance is that conservatives, when in control, continue to reduce funding (though usually simply by failing to provide adequate inflationary increases). They then plead that the programs are ineffective and should be replaced with private
alternatives.
Using dishonest calculations cloaked as reductions in “waste, fraud,and abuse” is in itself fraudulent and abusive. We need to demand that our legislators protect our public programs such as Part B of Medicare.
Failing that, we should replace them with legislators who will.
Date: Thu, 4 Sep 2003 10:26:29 -0700
Subject: qotd: Relaxing EMTALA rules will result in lethal outcomes
Department of Health and Human Services
Centers for Medicare & Medicaid Services
42 CFR Parts 413, 482, and 489
[CMS-1063-F] RIN 0938-AM34
Medicare Program; Clarifying Policies Related to the Responsibilities of Medicare-Participating Hospitals in Treating Individuals with Emergency Medical Conditions
ACTION: Final rule.
SUMMARY: This final rule clarifies policies relating to the responsibilities of Medicare-participating hospitals in treating individuals with emergency medical conditions who present to a hospital under the provisions of the
Emergency Medical Treatment and Labor Act (EMTALA).
Excerpt:
(2) Exception: Application to inpatients.
(i) If a hospital has screened an individual under paragraph (a) of this section and found the individual to have an emergency medical condition, and admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section with respect to that individual.
http://cms.hhs.gov/providers/emtala/cms-1063-f.pdf
And…
Institute of Medicine
Care Without Coverage: Too Little, Too Late
Hospital-based Care
The poorer health status of uninsured adults at the time of hospitalization is compounded by experiences as inpatients. They receive fewer needed services, worse quality care, and have a greater risk of dying in the hospital or shortly after discharge.
Traumatic injuries: Surprisingly, provider response to traumatic injury can be influenced by insurance status. Uninsured trauma victims are less likely to be admitted to a hospital, receive fewer services when admitted, and are more likely to die than are insured trauma victims.
http://www.iom.edu/includes/DBFile.asp?id=4160
Comment: The way in which a problem is framed greatly influences the approaches to solving the problem.
The administration has elected to define the continued application of EMTALA
standards to an emergency patient, once that patient is admitted, as a burdensome and unnecessary regulatory requirement. Their solution is to waive EMTALA rules for emergency inpatients once admitted. Relaxing this requirement can only compound the negative outcomes described in the Institute of Medicine report.
Others would define the problem as impaired outcomes and even death resulting from lack of insurance coverage for many emergency patients. Most of us would agree that the solution for the problem framed in this manner should be to ensure that everyone has adequate health insurance coverage.
Should our administration begin supporting policies that improve health care
outcomes, or should it continue to place a higher priority on policies that reduce government oversight of serious deficiencies that adversely affect the health of our citizens?
(Although this message addresses the waiving of EMTALA rules for emergency
patients who are admitted, an even more consequential change is in the relaxation of the rules for specialist on-call backup of emergency services.
More preventable deaths are inevitable. Although adequate specialist coverage will always remain a problem, the immediate solution is not to merely diminish the obligation of specialists to provide coverage, but rather to ensure that they will be compensated when their services are required. Again, ensuring that everyone has adequate health care insurance is the first step toward solving these problems. Removing the issue of compensation allows for a less heated dialogue on the other important on-call disputes.)