South Jersey is one of the less populated areas of the state and a tiny portion of America. Yet in just the past couple of years, it has seen major charges of criminal exploitation of government entitlement and benefits programs.
Local leaders, including Democrat Rep. Jeff Van Drew and Republican Atlantic County Executive Dennis Levinson, recently warned Medicare recipients of a common new threat to them and the health coverage program for older Americans. Scammers call seniors offering free medical equipment such as leg and back braces at Medicare’s expense, and at the same time solicit personal information to also rip off the seniors.
There is no reliable accounting of entitlement and benefits fraud, but the known amount is vast. A Toms River doctor was charged this month in a $13 million conspiracy to defraud Medicare with unneeded prescriptions for medical equipment. That was part of federal charges against 24 people, seven from New Jersey, who worked with companies and doctors to cheat Medicare out of $1.2 billion.
This is the kind of thing that should be rare, but it’s shockingly common.
A couple of years ago, a hospice care provider with a location in Marmora was charged with admitting Medicare patients who didn’t need hospice care for seven years. It paid $2 million and its parent company paid $2.4 million to settle the case. That same day, 22 people at another hospice, among them three of its Philadelphia owners, were convicted of criminal charges after their firm submitted $14.3 million in fraudulent claims to Medicare.
Last fall, the N.J. State Controller announced that its amnesty program for widespread Medicaid fraud in Ocean County had recouped $2.3 million from 159 who took advantage of it — and also reduced by $2.6 million their requirement to pay back what they unlawfully took.
A widespread defrauding in Atlantic County of New Jersey’s health benefits program for government workers is still being processed, with 23 guilty pleas so far, at least 200 public employees participants according to a Margate doctor involved, and charges that $50 million was bilked from the program and divided among members of the fraud ring.
The braces scam is reminiscent of another medical device Medicare fraud, the infamous motorized wheelchair scandal of several years ago. An investigation of that found that fewer than 3 percent of the 5 million or so claims received by Medicare every day are reviewed by anybody before they are paid — practically an invitation to fraud. Next time Medicare supporters brag about its low administrative costs, remember that is because it’s a check-writing operation with little effective oversight.
Gigantic government entitlement and benefits programs as currently operated result in widespread criminal enterprises. That undermines support for these essential features of a civilized society. It also wastes many billions of taxpayer dollars, raises fundamental questions about government competency and damages faith in democracy.
This issue of government-enabled fraud transcends discussions about the appropriate level of entitlements and government benefits. The size of such programs shouldn’t make their security and review impossible. As a condition of their existence and growth, they must ensure they don’t foster vast fraud that debilitates society. A nation or state that tolerates, almost encourages, crimes against its people is asking for trouble and needs basic reforms to guarantee its survival.