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Editorial: Medicaid fraud demands oversight |

Editorial: Medicaid fraud demands oversight

| Monday, December 10, 2018 3:33 p.m

We worry a lot about fraud in America.

Probably because every day we receive proof that we fell for it. Again.

One of the most recent examples was in Pittsburgh, where three people pleaded guilty in federal court to conspiring to defraud the state Medicaid program.

We worry a lot about the people who are doing this. We worry about the people who are trying to qualify for benefits they don’t deserve. We worry about people who should be paying their own bills and aren’t. We worry about people getting something we don’t.

Travis Moriarty, Tiffhany Covington and Brenda Lowry Horton all got something we didn’t, and it wasn’t a card that got them free health care.

It was $87 million.

Three people, working for four home health companies, along with a network of at least 13 conspirators, found a way to take $87 million in public funds illegally over eight years by “providing” home care services for people who weren’t at home due to hospitalization, incarceration or death.

We worry a lot about fraud that we imagine is happening, but it seems that we miss the big ticket fraud that is flagrantly walking out the door in front of us, waving fistfuls of cash and laughing.

It should be easy to find out if someone who is in jail is receiving a home health care visit across the county. It should be easy to find out if Medicaid is paying for someone’s heart surgery and home care on the same day. It should be easy to find out if a dead man is still generating new medical bills.

But apparently it isn’t easy enough to stop an eight-year scheme involving at least 16 people and four businesses.

We worry a lot about who the little people doing the fraud are. We want to stop the people from getting the benefits that we seem to believe are, in and of themselves, a kind of fraud. But that is a whole different conversation from the fraud that actually occurs.

We need to demand more oversight of the people receiving the money and submitting the bills, something that is way above the pay grade of the people too sick to get out of bed.

Just this one billing fraud conspiracy amounts to more than $29 for every man, woman and child covered by Medicaid or CHIP in Pennsylvania.

It is the fact that $87 million can seem like such a small amount distributed across the 2.9 million people covered by the program that makes it seem like the patients are the problem.

But we regularly see that people in positions with access to power and money will take advantage of that power and money for their own benefit, be it with Medicaid or municipal funds or a fire company’s checkbook. The common denominator in all of them ends up being oversight, because things go wrong when no one is watching.

We need to worry a lot about fraud. We just need to worry about it the right way.

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