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Life Health > Health Insurance > Health Insurance

On the Third Hand: A 'Catching Fire' spoiler column

By Allison Bell

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“The Hunger Games: Catching Fire” is a movie about a really messed up little post-apocalyptic country in which the dominant city takes a feudal approach to economic management.

The dominant city makes the other cities send it raw materials, then cracks down when the other cities object.

One of the creepiest scenes in the movie occurs early on, when the government punishes an uppity city by sending in police to destroy the city’s black market. The black marketers are breaking their country’s law but see themselves as just buying and selling goods people need, not doing anyone any harm that they understand to be harm.

That scene came to mind as I was looking at the boring, confusing written testimony for the Medicare fraud hearing the House Oversight & Government Reform Committee held Tuesday.

So, on the one hand, I was thinking about trying to cover the term, because the term “fraud” sounded interesting.

Then, on the other hand, I read the written testimony and realize that a lot of the allegations were really about obnoxious but rational providers trying to get around well-intentioned but complicated, counterintuitive, hard- or impossible-to-enforce regulations.

Medicare Advantage plans, for example, have to go through a complicated opinion letter process just to get official permission to do logical things like encouraging enrollees to see in-network providers. 

In some cases, providers run into trouble because they try to deal with a mishmash of funding rules and programs by engaging in Robin Hood-like efforts to use money from patients with some kind of good payment source to cover part or all of the cost of treating uninsured and underinsured patients. The providers may feel like they’re doing the right thing while they’re doing it, then look like the worst people ever when described in the language of a U.S. Department of Justice criminal conviction press release.

On the third hand, some of that fraud has obvious victims — patients who get too little care, or potentially harmful care — and much of it causes genuine harm, at least within the framework of the governing law.

On the fourth hand, it seems as if, when policymakers are designing health finance programs that include a lot of complicated calculations and restrictions, and a lot of serious penalties associated with those calculations and restrictions, it might make sense to try to edit the program to reduce the likelihood that authorities will spend a lot of time investigating and prosecuting people for crimes that would mystify the typical layperson.

If a health law imposes stiff penalties on providers that kill patients, or use their bank account information to buy boats, that kind of wrongdoing is easy to understand.

If a health law imposes penalties for complicated accounting infractions, is there a way to redo the program to sharply reduce the opportunities people with weak ethics or poor self control have to cook the books?

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