Something’s rotten about home health care in Dallas.These are vast numbers: 800 area businesses collectively defrauding Medicare of nearly half a billion dollars! Extraordinary! And the issue is not isolated in Big D.
So far this year, federal investigators have brought charges against several area doctors and nurses, alleging they billed Medicare for more than $475 million in fraudulent claims. The cases involve at least 800 home health care agencies in the Dallas-Fort Worth area that are accused of participating in the schemes.
The owners and operators of five of those agencies are facing fraud charges. An additional 78 have seen their Medicare reimbursements suspended while investigators comb their records. For the rest, federal prosecutors say their investigations continue.
“There are several people now — agents and prosecutors — working up these cases, people who are devoted full time to do these cases,” said a Justice Department official who spoke on condition of anonymity. He characterized the indictments to date as “just the tip. There’s still a lot more cases to be brought.”
In urban areas across the country, Medicare paid for an average of 14.4 care episodes for every 100 beneficiaries in 2010. In the Dallas-Fort Worth area, the rate was more than double that — 38 cases per 100 beneficiaries.Prosecution provides a stick, but there's an homage at the end of the story to the reality that a long-term solution must be structural and preventive, not relying just on cops, prosecutors and jails to prevent corporate crime. "The Partnership for Quality Home Health Care, a national organization representing more than 1,500 home health care companies, told Congress this summer that the new “aberrant payment prevention” software saved $853 million in 2010 and could save another $11 billion over the next decade."
(The seven highest rates in the country were recorded in South Texas. Brooks County had 150.4 episodes of care for every 100 beneficiaries, according to an analysis this year by the Medicare Payments Advisory Commission.)
Texas has more claims than other states in part because it does not require home health care agencies to get a “certificate of need” before setting up a business, the commission noted. Many other states limit the number of home health care agencies by requiring them to spell out the need for their services.
In the end, while it's necessary to punish white collar criminals to provide some disincentive for what's alleged to be rampant cheating, there's also a responsibility for government to prevent cheating through its own systems, which is where, according to the News, the process fell down with Texas' failure to effectively regulate home health providers. This is a case where Texas' unwillingness to regulate business has allegedly facilitated outright criminality. Businesses may dislike regulation, but surely they also dislike competing in an industry full of fraudsters who are dealt with, though rarely, mainly via prosecution.
A second Morning News story by Tanya Eiserer and Steve Thompson ("Changes to Dallas police shoplifting policy spur drop in crime rates," Oct. 6) details changes in Dallas police record keeping for petty, Class C shoplifting thefts in a way that made reported theft artificially drop this year. The Chief dubiously claimed a major drop in petty theft was not "because of a new policy that makes it harder for store owners to report shoplifting cases under $50." Instead, "Police Chief David Brown last week disputed that finding, saying the low numbers of reported retail thefts are the result of good police work, not the change in reporting policy. He said his department’s new crackdown on “fences” — people who buy and sell stolen goods — drove shoplifting lower."
Whether that claim is justifiable (and it's probably not), the underlying policy IMO was sound. "The change in the response policy freed up officers for the [anti-fencing] task force, Brown said. The idea was to treat theft cases much like drug cases, focusing on big operations rather than individual small-time criminals."
A comic-store clerk complained of extra paperwork now required to report a theft, declaring, "Last time I checked, the police are there to protect me, not to have me do their paperwork.” OTOH, he's afforded the shopkeeper's privilege, so if he wants to exercise that privilege, perhaps it's not unreasonable to oblige him to fill out some forms. In any event, according to the News, as soon as the new paperwork was required there was a rapid dropoff in reported shoplifting:
An analysis of the year’s petty shoplifting reports suggests that store operators like Shorr have become less likely to report minor shoplifting incidents. The reports plummeted Jan. 5. That’s exactly the day the new reporting policy took effect.
Before that date, minor shoplifting offenses averaged about 10 a day. Immediately afterward, that average fell to fewer than three a day. The average has remained steady at that lower level since.
With police recording about seven fewer petty shoplifting offenses a day, the reductions have accumulated. By the end of August, petty shoplifting had fallen by 1,692 reports — 73 percent — compared with the same period the year before.Let's extrapolate. If the department previously received an average of ten reports of Class C shoplifting per day and the number reduced to three because of the new policy, that would mean DPD formerly took 3,650 such reports per year and the paperwork requirement reduced it to somewhere in the neighborhood of 1,100 per year. So let's say the real number should be 3,650 and the average amount stolen (a generous estimate; I have no idea what the real number is) was $40 per incident, then the total amount stolen would collectively come to $146,000.
Now compare that $146,000 worth of societal cost to the $475 million in allegedly fraudulent claims by 800 Dallas area home-health companies, with more potential Texas targets so far un-prosecuted.
Certainly, shoplifting is the kind of public order offense that can't be allowed to run rampant, but businesses are responsible for their own security as it regards Class C theft, and as the Morning News story noted, the larger retailers devote considerable resources toward low-level "loss prevention." Just as Medicare is installing preventive mechanisms, some responsibility for theft prevention falls on businesses themselves.
At the same time, it often galls me to see so much attention paid to petty criminals like Class C shoplifters, who are more pathetic than dangerous, while corporate criminals - whether on Wall Street or at DFW-area home health agencies - are robbing the public blind, in this case allegedly stealing more than three-thousand times the amount annually attributable to Class C shoplifters in Dallas. Those undetected financial crimes don't show up in crime statistics, just like the Class Cs now missed in the records because Dallas shopkeepers don't fill out their paperwork. But as a taxpayer, I'm a lot more concerned about the white-collar offenses we don't hear about than I am Class C shoplifting thefts that never made it into the record.