As reported by ReimagineAmerica

Congratulations to the FBI for their “take-down” of a $100M Medicare fraud ring on October 13,2010.  According to the NY Times October 14 morning addition, the “band of Armenian-American gangsters” billed Medicare for more than “$100M by inventing 118 bogus health clinics in 25 states”.  According to the paper, the gangsters made off with $35M in cash that cannot be recovered.  You will find a link to the NY Times news story at the end of this blog.

How did this happen?  It happened because Medicare is a wholly automated payment system that is notoriously porous.  If the SSN number of both patient and doctor are validated electronically, and the treatment code is separately validated electronically, an electronic payment is generated.  Only after the payment is any audit performed.   Often, but not always, the audit happens only when a recipient reviewing their own Medicare statement reports activity they know to be fraudulent, according to the CBS 60 Minutes exposé filmed in Florida, earlier this year,   I suppose that Medicare subscriber doctors, also,  report fraud when the IRS accuses them of under reporting their income?

The 2010 Health Care Reform legislation did include funding for Medicare fraud detection.  But focusing on investigation after the fraud occurs and on TV warnings to Medicare recipients urging them to “guard the card” will not solve a problem estimated to be at least $50B – billion with a B – dollars a year!  In fact, the legislation expects these efforts to save only $2B a year – 4% of the estimated reduction in benefit payments mandated by the Act.   Wow we need to do 96% better or cut seniors’ benefits, according to Congressional Budget Office estimates!

Last week Fox Business News reported, and an IBM spokesman confirmed,  that Sam Palmisano, CEO of IBM,  told Barack Obama that IBM had carefully studied the Medicare fraud issue and estimated the actual 10 year problem to be closer to $900B – that’s billion with a B — over ten years.  Mr. Palmisano believes so strongly in both IBM’s numbers and IBM’s potential solution that he offered to “build” the  solution for “free”.  Fox reported that Barack Obama turned down this offer.   Can you imagine, an American CEO of an American corporation offers a solution that could, potentially, save 90% of the projected health care reform deficit and the President of the United States turned down the offer?

I was astounded – so astounded that I knew I needed to verify the story before I gave full vent to my frustration.  So I Googled “IBM Medicare fraud”.    Turns out that it’s true!  IBM confirmed it. 

There is no mystery here.  Health care is a great business opportunity for IBM.  IBM Health Care Practice works with partners every day in both the United States and Europe to improve the use of technology to simultaneously reduce the cost of delivering health care and improve health care outcomes.  

It is important to examine my Palmisano’s language carefully.   He offered to “build” the solution for free to “prove” it worked.  He never said, IBM didn’t want to be paid if it worked.  He was willing to “share the risk”.    That has been a standard practice in business for years!  Time that we adopted these money saving practices in the government as well. 

Why would the President turned down such an offer?  Certainly he knows that all major technology initiatives in federal government are done by private contract vendors?   So what’s up?

  1. Most benignly, he does not want to appear to promote one federal vendor over others?  That can easily be dealt with in the contracting process – requiring IBM to partner with other major software and hardware vendors to develop an “open source” solution. 
  2. Can it be the President, who has no business experience,  does not understand the concept “investing in a new business opportunity”?    Mr. Palmisano is not an altruist.  Successfully ending Medicare fraud would further strengthen IBM’s “qualifications” as a global health care solutions provider.  This would be worth billions in new profits to IBM and its partners.
  3. Can it be possible that the President really has such a deep-seated distrust of business and business executives that he cannot imagine a CEO can be a patriot at the same time that he is responsible for producing share holder value? 
  4. Could the President fear that accepting this offer might be seen as a public rebuke of the team at Medicare, who are all SEIU or AFGE members?  Could he be concerned that such a perception would have political ramifications as he looks to government union support in his 2012 Presidential election?

Based on CBS and the New York Times reporting, I can think of a half dozen “quick hit” changes to the existing Medicare payment process that would produce billions in potential Medicare fraud savings.   So,  its easy for me to believe that the full force of IBM, IBM partners,  the Medicare staff, and the FBI could eliminate $900B in Medicare fraud over the next decade.

Personally, I believe that Mr. Palmisano is acting both as a patriot and a good CEO.   Mr. Obama, what do you have to lose?