Waste, Fraud & Abuse (Editorial)

Wherever there are human beings, there will be waste, fraud and abuse. There is waste in your household budget. In any business of any size, someone is abusing a policy or a credit card. There is fraud even in churches and the PTA.

But hardly any human institutions present the opportunity for waste, fraud and abuse on the scale that we’ve seen in Medicare and Medicaid. And the revelations just keep on coming.

In 2013, our Senior Editor Mark Friedman wrote an award-winning report on Dr. Stacey M. Johnson, a Mountain Home physician who died before federal authorities discovered that he had overbilled Medicare by at least $14.7 million. This week, Friedman has another front-page story about a Little Rock elder-care provider that allegedly submitted thousands of fraudulent bills to Medicaid in less than a year.

And last week the Arkansas Democrat-Gazette’s Chad Day recounted, in shocking detail after shocking detail, millions of dollars’ worth of Medicare bills for more work than one Mountain Home social worker could possibly perform.

The social worker, Thomas Craig Burns, blamed his wife for messing up his billing. Step-by-Step Senior Care Inc. similarly blamed the person doing the billing — and, indeed, Dawna Kincade has been charged with felony Medicaid fraud. But blaming one person doesn’t pass the smell test, even when the dollars involved are private rather than public.

Our state created an Inspector General for Medicaid in 2013, and that is a good start. That office followed up on a report from a sharp-eyed mother to bust out Step-by-Step and Kincade.

But surely both state and federal governments could have better systems for flagging claims that can’t possibly be true. If millions are being stolen by bad actors in Arkansas, billions are being stolen by bad actors across the country. Patients rarely cheat the system, but patients will ultimately pay the price if providers can suck the programs dry with impunity.