When fraudsters thrive and programs fail: A $1B wake-up call

$2 million here. $10 million there. Another day, another brief detailing the latest allegations and convictions for DME fraud in the federal Medicare program. 

“Why,” I recently asked Editor Liz while typing up the latest fraud item from the DOJ, “do people risk their freedom – and their good name – for a measly few million bucks?” 

Well! This latest one turns out to be a fraud scheme to the tune of $1 billion for medically unnecessary equipment (read: braces). 

$1 billion! To be clear, the amount paid out by Medicare and other insurers was only a mere “more than $360 million” based on the fraudulent claims. 

Do the people who get into these schemes just fall into them, getting in deeper and deeper, lying awake at night, sweating over their predicament? Or are they dreaming of buying yachts? 

Even more shocking, while we often don’t recognize these bad actors (I suspect many are sham operations begun with bad intention), in this case, it’s one Gary Cox, CEO of Power Mobility Doctor Rx (DMERx). We interviewed him back around 2016 when he, presumably, launched the business with an eye toward helping others and making an honest buck? 

Meanwhile, we’ve got an administration hyper-focused on eliminating fraud, waste and abuse. I’m not so sure that DOGE, which mercifully seems to be receding from the headlines, has accomplished this so much as it has chain-sawed its way into havoc for thousands of people, programs and communities. 

And now CMS is dusting off the failure that is the Medicare competitive bidding program. You know, the one in which, after all was said and done, didn’t result in savings and so the agency itself scrapped most of it. Alas, by then, scores of businesses had shuttered and beneficiaries suffered.  

While the government is comprised of many thousands of dedicated and brilliant people, it has always lacked common sense, so bound up as it is with bureaucracy. If it wants to root out “fraud, waste and abuse,” it should start by locking the barn door before the horse gets out and gallops off into the sunset. 

Instead, the government should focus on saving dollars by focusing on patient outcomes and less costly sites of care – namely the home.