I ask the pardon of my readers for the brief absence from this space. Due to work-related volumes, the Fi-Med blog has been delayed, but we now return to bring you the latest in audit news and healthcare trends.
As I have opined in this space previously, a virulent orthodoxy has embedded itself into the halls of Washington, D.C., and slowly to the rest of the country, that private enterprise can always perform basic tasks better than the government can on its own. A deep look into every Cabinet-level agency can find some example of bureaucracy run amok, yet with the blood-lust for private contracting in all areas of government, a new paradigm has emerged. What was once a government that worked slowly, and within a set of defined rules, is now in the hands of a private sector that fights to justify its existence as a contract holder by any means necessary. As a codicil to this shift, it appears that once a company receives a government contract, there is no behavior so egregious that the contractor doesn’t stick around in one form or another doing something at the expense of taxpayers.
The Centers for Medicare and Medicaid Services, based on their independent contractors, has under its umbrella some of the worst examples of this behavior. It is a seldom-spoken truth that CMS contractors never really go away, but rather metamorphose into something else that takes its money from the government in the form of a contract for services.
The Office of Inspector General overseeing the Medicare program released a report on July 9th that shines a light on the shell games that go on with Medicare contractors, in this case with Zone Program Integrity Contractors (ZPIC). The OIG decided to take a look at the relationships between the ZPIC contractors and their subcontractors to assess conflicts of interest that could hinder their work product.
In reviewing the contractors, the OIG identified 10 actual conflicts and 1,451 possible conflicts with the companies who are now either contractors or subcontractors under the ZPIC program. These conflicts were related to contractual relationships either with CMS or with other contractors of CMS that provide various other services. In most cases, the companies analyzed did not consider these internecine relationships to be actual conflicts, more than likely because CMS does not have a written policy for reviewing conflict of interest information.
Now, let’s combine this information with another OIG report that was released this past November, which showed that data issues between CMS and the ZPIC contractors has severely hindered the work product of the ZPIC program. This same report stated that over the history of the Program Safeguard Contractor (PSC) and ZPIC programs, less than 2% of all dollars identified as fraudulent have been collected by the contractors.
The picture that is beginning to emerge on the ZPIC program is beginning to look less like Ansel Adams and more like Ralph Steadman. What we have are contractors, aggressively going after identified “fraud” targets, that may very well have a monetary interest in pursuing one target over another, at the expense of the entire Medicare program. With actual results rating so low on the completion scale, I may very well have stumbled upon the best example of private enterprise siphoning contract funds out of CMS for no other reason than to prop up private industry to satisfy orthodoxy. Unfortunately, it is taxpayers and medical providers attempting to do the right thing that pay the penalty under this belief system.