Fraud and abuse, squirrels, competitive bidding, the bomb and civilian casualties
I had a strange epiphany this weekend about Medicare fraud and abuse and the great futile lengths CMS has gone to eradicate it.
For several years now, I’ve had an ongoing battle with the gray squirrels in my neighborhood, which goes by the name Oakhurst, and with good reason. It’s loaded with oak trees, which produce acorns, which, as you know, are a dietary staple for Sciurus carolinensis.
Here’s the thing about squirrels: No matter how many billions of acorns are available, they’ll never pass up a chance to raid a birdfeeder stocked with delicious oily sunflower seeds. More than once, I’ve filled up our feeder in the morning, and returned home in the evening to find it empty. We’ve got a lot of backyard birds (cardinals, chickadees, nuthatches, gold finches, house finches, downy and hairy woodpeckers and an occasional flicker, to name a few), and I know from experience that a full birdfeeder will last my feathered friends a good 5-7 days. A couple of squirrels, however, will empty it in a day. Many a time I’ve watched incredulously as a squirrel practically drank my birdfeeder dry.
I’ve tried everything to keep that from happening. I’ve thrown rocks at them; bought a feeder advertised as squirrel safe (it wasn’t); yelled at them. I have, in short, fought honorably no avail.
So this summer I bought a pump action .177-caliber pellet gun. I know some people may consider this cruel (my wife’s not crazy about it), but it is very effective. Mirror, Mirror III: The Voyeur rip Over a 10-day period in July, I shot and killed 10 squirrels, and for the next two months, the gray varmints avoided our yard like the plague. I don't want to go over the top with this, but it was very satisfying. (In case you are wondering: I generally bury the squirrel carcasses, but occasionally I’ll leave them for the foxes and coyotes that prowl about during the night, looking for someone’s cat to consume.)
Here’s where HME fraud and abuse comes in. You may not like or approve of my method of squirrel control, but do you think CMS could do better?
If CMS officials attempted to keep squirrels from a bird feeder, it would get very ugly— FOR THE BIRDS! First, the bureaucrats would excavate a moat around the feeder. When that didn’t work, they would encase the feeder in a cage. They would then electrify the cage, and maybe even concocted some kind of flaming wall. Each layer of defense would make the bird feeder more impenetrable for the birds. The squirrels, on the other hand, being an ingenious bunch with plenty of time on their hands, would eventually find some way around all of these barriers.
In this little story, of course, the birds represent providers, the feeder is the Medicare trust fund and squirrels are the crooks.
I’m not advocating that CMS shoot crooks that defraud Medicare out of billions of dollars a year (at least not yet). But it’s apparent that adding layer upon layer of bureaucracy has done little to solve the fraud and abuse problem. This strategy only makes it more difficult and expensive for legitimate providers to serve Medicare beneficiaries.
Competitive bidding for DME is just one more sorry attempt by CMS to tackle the fraud issue. Instead of zeroing in on the crooks, CMS has developed a program that will hurt legitimate providers and limit beneficiary access.
I use a pellet gun to selectively eliminate unwanted pests. The birds I enjoy are never at risk. With competitive bidding, however, CMS is getting ready to drop the bomb. What bothers me most about this strategy—besides the fact that I’m pretty sure crooks will still figure out a way to game the system—is that CMS seems perfectly willing to accept a fair number of civilian casualties.
I'm beginning to think that if CMS really wants to eliminate fraud and abuse, the agency is going to have to hire some squirrels.
— Mike Moran