Analysis / Opinion:
Editor’s Note: This is one of the series examining the Constitution and the Federalist Papers in the United States today.
When thinking about the constitution, we often focus on what has happened or is simply wrong. From time to time it is useful to consider how our constitutional process and boundaries have been effective and result in a government that is better, more accountable, more adaptable, and if something is broken it Will be able to heal itself.
We value the Congress process, which involves deliberation and debate and is informed of the evidence, public sentiment and even the constitutional mandate of the judiciary.
A good example is the recent congressional consideration of the Lange Mule Act.
2,500 years ago the Greeks thought the earth was flat. Five hundred years ago, most Europeans believed that the earth was the center of the solar system. More than 100 years ago, physicists believed that electrons were embedded in the nucleus of an atom.
For the past 50 years, Congress has believed that increasing legislation to combat fraud and abuse in government-funded programs would save taxpayers money. That doesn’t have to be true.
Unfortunately, no one has ever conducted an experiment or a study to determine if fraud and abuse laws save the government anything. There is a real possibility that these laws cost more than their savings. We will never know unless we study them.
This is all because Congress is considering amendments to the False Claims Act, used by the government and whistleblowers to prevent fraud and waste. The False Claims Act, also known as the Lime Mule Act, was originally passed in 1863 when a purchasing officer asked for a kickback to buy a herd of lame mules for the army.
The law prohibits a person from using false or misleading statements to obtain government funds and imposes fines and penalties.
In 2016, the Supreme Court ruled that under the law, the federal government had to prove that a false or misleading statement was subject to the government’s decision to pay the claim. Thus, minor misunderstandings that do not affect the claim being paid were not subject to the Act.
The Congress now wants to change the law so that the government no longer has to prove materialism. The proposed amendment has mutual support, such as Maternal and Apple Pie.
What could be wrong? About 80 to 80% of cases involve healthcare, usually Medicare or Medicaid. Because the fines are so high, most in the healthcare business – hospitals, pharmaceutical and instrument companies, physician groups – have expensive compliance programs.
These compliance programs cost money and appear on most balance sheets as overhead. Under Medicare, overhead physician fees are included in the schedule, prices of medicines and equipment, and hospital payments. Most Medicaid programs are similar. In this way, taxpayers eliminate the need to pay compliance costs.
The unfortunate fact is that we do not know whether the cost of complying with the Act exceeds the savings from compliance. We know that lawyers’ fees and whistleblowers are important (up to 30%, as a reward). I should know I defended the False Claims Act through two kids in college.
Why should you care? Lawyers’ fees and prevention costs contribute $ 1.3 trillion, which we all pay for “healthcare” transactions nationwide. These are costs that are not necessary for the provision of health care services.
As we consider Congress, we will probably hear numbers that look impressive but are meaningless. The Department of Justice, for example, is proud to have received approximately 8 1.8 billion in healthcare under the Act last year. That’s less than 50 cents for every $ 1,000 spent on healthcare.
We do not know how much was spent on compliance at the national level and how much these expenditures prevented wrongdoing. It is shocking that when Congress considers new fraud and abuse laws, no one has bothered to determine whether they are sensible or not.
That is why we spend twice as much on healthcare as any other nation, with poor results and in many cases worse. Unfortunately, most of those who understand the actions of the Act are in conflict with personal interests. Even the Department of Justice receives an allocated allocation, and the Inspector General can increase his budget by recovering false claims.
The constitutional process can be messy and frustrating, especially the legislative process. But when they are followed, they give the best results. Before Congress passes another “Flat Earth” bill, lawmakers must use the least real expertise to assess the real financial implications of any amendment, without economic interest in the results. Doing otherwise is not only foolish and shameful, it is also against their responsibilities under the Constitution.
۔ Robert Charro was a former General Counsel for the US Department of Health and Human Services.