DATE: Thursday, July 24, 1997               TAG: 9707240013

SECTION: LOCAL                   PAGE: B10  EDITION: FINAL 

TYPE: Editorial

                                            LENGTH:   71 lines

MEDICARE MISMANAGEMENT WHERE'S THE OUTRAGE?

Medicare is an essential government program that also happens to be disgracefully mismanaged. If the Republicans in Congress and President Clinton want to make a show of bipartisanship, they could do worse than to quit squabbling about how to defund Medicare and start worrying about how to redeem it.

A new audit by the inspector general of Health and Human Services reveals the obvious. The gigantic program has gigantic problems that permit shameful waste and abuse. There's nothing new about this report except the level of detail. The scandal has been evident for years and is fully bipartisan.

The numbers are mind-boggling. Medicare has 38 million beneficiaries who made 800 million claims on the system last year. There are 979,000 authorized providers whose services are governed by 45,000 pages of rules. Not surprisingly, this impossibly complex and confusing program is awash in error and abuse.

The audit estimates that 30 percent of claims don't comply with the law, in many cases because the law can't be understood by mere mortals. There were $23 billion in overpayments in 1996 - 14 percent of all the money spent on the program. Nine percent of the overpayments could be traced to simple billing errors and mistaken codes. But that leaves 91 percent of overpayments running the gamut from claims honestly but incorrectly made to systematic fraud.

To steal a line from Bob Dole: When a third of all claims in a $250 billion program are questionable, where's the outrage? In fact, quite a lot of impotent outrage is expressed by those who actually have to deal with the system - providers on one side, patients on the other. They know the paperwork maze they are forced to deal with is hopeless.

Far from being an impediment to cheating, this lunatic complexity actually abets it. Submit a claim that is disallowed and you learn why it was rejected and how to get it accepted the next time. Thus, those so inclined can use the system as a teaching machine. And since penalties are rarely imposed and are generally a slap on the wrist, fraud is further encouraged.

To begin addressing the problem, some heads should roll. Present administrators were told to clean up their act some time ago and have failed. But beyond that, fundamental fixes are needed. The rules must be streamlined and put into plain English. It is difficult under the present system to determine who is being paid how much for what.

Claims also must be monitored much more closely. It is shocking to learn that this audit is the first such in the program's three-decade history. It revealed not only widespread abuse but books in such disarray that it was difficult to determine what was going on. That argues the need for a lot more fiscal cops on the beat.

Finally, penalties need to be more painful and imposed more often. If there's no real cost to scamming the system, trimming, cheating and outright fraud will burgeon - as they have done. As a society we tend to obsess about street crime and turn a blind eye to white-collar abuse. But billion-dollar ripoffs practiced by prosperous doctors and hospital administrators who can hardly claim they are driven by want are at least as shameful as the predations of those on the fringes of society.

Our politics tends to pit those who want to create new government programs against those who want to cut existing government programs. That leaves no one to take responsibility for the hard work of managing the important government programs we've already got.

The Republicans are often identified as the party of business. That ought to make them willing and able to put Medicare on a businesslike footing. There's nothing businesslike about the present Byzantine bazaar with its waste, excess and folly. Taxpayer dollars are squandered, the unscrupulous are enriched and the customers are confused and maltreated.

Medicare cries out not for the usual slash-and-burn solution, but for streamlining and rationalizing. It needs order, discipline and control. Those who do a good job need to be rewarded, and those who abuse the system need to be punished. The French are good at bureaucracy. We are supposed to be good at management. Medicare needs to be managed. Now.

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