Attorney General Merrick Garland recently announced a new crack-down on healthcare fraud. “We will bring to justice criminals who defraud Americans and steal from tax-payer [funded, patient care] programs.” One hundred and ninety-three individuals have been charged with medical fraud estimated at $2.75 billion. Two have already been indicted.
People who divert healthcare dollars from paying for medical care to pay themselves, should certainly be held accountable by the Department of Justice (DoJ.) But, what if the perpetrators are Washington bureaucrats?
The frauds being investigated by Garland’s DoJ include the following. A pharmaceutical distributor in Florida that reputedly sold adulterated or misbranded HIV drugs. Two wound-care companies in Arizona that provided purportedly unnecessary and highly expensive skin grafts to elderly Medicare patients. A telemedicine company that provided stimulants drugs, viz., Adderall, supposedly for “no legitimate medical purpose.”
In-the-trenches physicians cannot simply take the word of federal officials that these actions were in fact fraudulent for two reasons. Official Washington has thrown away the trust of the American public. First, CoViD provided real world, clinical (not Fauci-like bureaucrat) doctors ample evidence of scientificly wrong and medically injurious pronouncements and mandates from Washington, viz., the mRNA CoViD gene therapy. Second, Garland’s investigations likely were initiated by whistleblowers who stand to gain considerable profit from government seizure of $230 million profits.
Accepting for the moment that the activities were medically inappropriate and fraudulent, DoJ should be congratulated for rooting out bad behaviors by medical providers. However, the frauds investigated by Garland are a pittance compared to the volume of dollars Washington fraudulently takes every minute.
Fraud is defined as “wrongful or criminal deception intended to result in financial or personal gain.” When someone takes money from its intended purpose and profits personally from that taking, that is fraud. The entire structure that Washington has created to regulate healthcare meets the definition of fraud. It is a massive system that “wrongfully” diverts money intended for patient care to pay bureaucrats who “personally gain” jobs and taxpayer dollars.
Consider the process from passing healthcare legislation to what average Americans – patients and providers alike – experience. For instance, passing price transparency rules does not, simply by the stroke of a pen, magically make price lists available to patients who need medical care.
When Washington passes any legislation, healthcare or other, per force they create BARRCOME. They create a legal and political structure that must be populated by bureaucrats (B) and administrators or agents (A). Lawyers and self-styled experts must write rules (R) that reflect the legislation passed, followed by actionable regulations (second R). Those affected by the legislation must comply (C) with the regulations and overseers (O) must be hired to confirm such compliance. The rules and regulations generally involve specific mandates (M) such as the CoViD injections, and finally, penalties for non-compliance must be enforced (E). This is true whether the act of non-compliance is a CoViD “jab” refusenik or a hospital that published false prices.
All this BARRCOME and the millions of new, highly paid hires consume taxpayer dollars. There are more compliance overseers in Texas Health and Human Services Department than there are doctors in the Lone Star State. The ACA alone cost $1.76 trillion. Senator Sanders admitted his single payer health plan could cost up to $40 trillion. That expenditure on one country’s healthcare system would represent 36 percentage of the combined GDP of all nations on planet earth.
Estimates of the annual cost of BARRCOME range from 31 percent (1999 study, pre-ACA) to a more recent projection (2019) of more than 50 percent of U.S. spending on its healthcare system. Since the U.S. expended $4.5 trillion in 2023 on healthcare, 1.4 trillion to 2.25 trillion “healthcare” dollars were diverted from paying for patient care to pay bureaucrats.
These “healthcare” trillions stolen by bureaucrats to pay bureaucrats meet the definition (above) of fraud, but on a scale that makes the Garland fraud investigation pale to insignificance: $2.75 billion versus $2.25 trillion.
As an example of this fraudulent bureaucratic diversion of healthcare dollars, recall $716 billion former President Obama’s namesake legislation took from the Medicare Trust to pay for BARRCOME in the ACA (colloquially Obamacare.) This money was diverted from paying for seniors’ in-patient hospital care to pay for ACA BARRCOME. For additional evidence of the ACA’s Byzantine bureaucratic structure and consequent astronomical costs, refer to the organizational chart developed by former Representative Kevin Brady of Texas.
The feds often point to fraudulent providers or venal Big Pharma as culprits for unaffordable costs of U.S. healthcare. Washington ignores fraud associated with its own BARRCOME and payments to the federal bureaucrats. To do so, they would have to investigate themselves.
Deane Waldman, M.D., MBA is Professor Emeritus of Pediatrics, Pathology, and Decision Science; former Director of the Center for Healthcare Policy at Texas Public Policy Foundation; former Director, New Mexico Health Insurance Exchange; and author of 12 books including multi-award winning, Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.
