(en) US, Miami Autonomy & Solidarity MAS* - Foxes and Henhouses: Austerity and the false dance of healthcare fraud by -SN Nappalos

Healthcare fraud is a big deal. The Federal Bureau of Investigations (FBI) estimates that
tax payers are on the hook for around $80 billion per year of fraud.[1] In 2011, the FBI 
had a record year retrieving $4.1 billion from fraudulent practitioners and businesses.[2] 
The Department of Health and Human Services discuss, in their 2011 annual Health Care 
Fraud and Abuse Control Program Annual Report, the fact that the Affordable Care and 
Patient Protection Act adds new measures, money, and efforts to combat the pervasive fraud 
that plagues our health care system. Our system that is that mixes profit and personal 
gain at each step of the industry.[3] Florida is a crucible because of the combination of
vast wealth, poverty, and abuse.

The FBI calls South Florida specifically as ?ground zero for the multi-billion-dollar 
criminal industry of health care fraud?.[4] Miami-Dade county itself has wide gaps between 
the rich and poor, and contains cities that have both the highest and lowest rates of 
people with healthcare coverage in the nation. Florida itself has low insurance coverage 
at nearly 20% of the state without any coverage at all (ignoring those who have only 
nominal coverage).[5] Clearly this environment contributes to the vast abuse of Medicare 
and Medicaid money centered in South Florida.

It is in this context that the Palm Beach Post reports the loss of federal anti-fraud 
money by Florida.[6] Large cuts to the Florida Medicaid anti-fraud body disqualified the 
state from additional assistance normally given by the federal government through matching 
funds. When fraud is at an all time high, and South Florida is the capital of healthcare 
fraud in the country, dozens of positions are held unfilled, budgets are being slashed, 
and key projects unfunded.

It?s worth reflecting on the fact that similar arguments are made against public safety 
net programs like Medicare and Medicaid because of fraud as well as for calls to cut the 
programs. These austerity measures come down to targeting programs aimed at the most 
vulnerable elements of society (disproportionately women, children, oppressed minorities,
and the working class) for which there are no alternatives that could pick up the slack. 
There simply is no profit to drive private sector solutions for people who can?t pay. 
While the ruling powers push ideas that in effect come down to large decreases in the 
basic standard of living for Americans, the implementation is contradictory. We see here 
that the attack is across the board including fraud units, which would in theory help 
reduce the burden on public money. Austerity measures are being forced onto programs which 
both harm society as a whole as well as cripple the agencies.

With fraud there is an alternative. Driven by both poverty and an incentive to profiteer 
off a system in which the public is on the hook for private gain, our healthcare system is 
fraud infested. The answer is to remove the fundamental forces that drive fraud. 
Healthcare employees and businesses should be payed to provide services to the community 
as a whole, without receiving financial incentives to provide additional services (a 
situation which also drives unnecessary procedures, lengthy hospital stays, and abuse). 
Likewise, the companies that leech the bulk of profit from the system (in terms of 
manipulating patents, inflating the cost of drugs and machinery, and wasting billions on 
advertising) should be capped. For decades science has been driven by diligent researchers 
working to advance their fields, rather than the drive to quick profits which churns out 
situations like companies re-patenting drugs available for 50 years in new delivery 
systems. Lastly, we need to take the power to call the shots out of the hands of 
politicians, business leaders, and the powerful. As long as people stand to benefit from 
these decisions, they will continue to use the system for their own personal advancement.
The community should have the power to decide how money will be spent on who, and what 
type of care they will receive. That will take a fight where people need to join together
and impose democracy onto a corrupt and authoritarian system.

Post script: Since this article was written, the Governor has announced a budget with 
further cuts to medicaid as well as rejecting the expansion of Medicaid under the 
Affordable Care Act that would bring additional federal money for additional Medicaid 
coverage.

[1] http://www.fbi.gov/about-us/investigate/white_collar/health-care-fraud

[2] 
http://www.fbi.gov/news/pressrel/press-releases/health-care-fraud-prevention-and-enforcement-efforts-result-in-record-breaking-recoveries-totaling-nearly-4.1-billion

[3] https://oig.hhs.gov/publications/docs/hcfac/hcfacreport2011.pdf

[4] 
http://www.fbi.gov/news/stories/2012/november/putting-the-brakes-on-health-care-fraud/putting-the-brakes-on-health-care-fraud

[5] http://www.bizjournals.com/orlando/news/2012/09/12/census-uninsured-rate-drops-in.html

[6] 
http://www.palmbeachpost.com/news/news/floridas-medicaid-fraud-fighting-cuts-cost-state-m/nTmXq/
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