Little Evidence that Undocumented People Get Medicaid

Many posts have discussed federal deficits and the federal debt. Americans vastly overestimate the amount of waste in the budget

Phil Galewitz at KFF:

Last August, as part of the federal government’s crackdown on people in the country illegally, the Trump administration sent states the names of hundreds of thousands of Medicaid enrollees with orders to determine whether they were ineligible based on immigration status.

But seven months later, findings from five states shared with KFF Health News show that the reviews have uncovered little evidence of a widespread problem.

Only U.S. citizens and some lawfully present immigrants are eligible for Medicaid, which covers health care costs for people with low incomes and disabilities, and the closely related Children’s Health Insurance Program. Both programs are administered by states.

Spokespeople from Pennsylvania’s and Colorado’s Medicaid agencies said, as of March, the states had found no one who needed to be terminated from Medicaid. That was after checking a combined 79,000 names.

Texas has reviewed records of more than 28,000 Medicaid enrollees at the Trump administration’s request and terminated coverage for 77 of them, according to Jennifer Ruffcorn, a spokesperson for the Texas Department of Human Services.

Ohio has checked 65,000 Medicaid enrollees, of which 260 people were disenrolled from the program, said Stephanie O’Grady, a spokesperson for the Ohio Department of Medicaid.

In Utah, 42 of the 8,000 enrollees identified by the Trump administration had their Medicaid coverage terminated, said Becky Wickstrom, a spokesperson for the state’s Department of Workforce Services.

Why DOGE Failed

Many posts have discussed federal deficits and the federal debt. Like previous efforts to reduce the deficit by cutting "waste, fraud, and abuse," DOGE was a failure.

At The Dispatch, Jessica Riedl writes that DOGE was incompetent and illegal.  Most important, its assumptions were wrong.

The promise to save trillions of dollars was ultimately doomed by the reality that most federal spending was off limits to DOGE. Roughly two-thirds of all federal spending goes to five items (Social Security, Medicare, defense, veterans’ benefits, and interest) that Trump either promised not to cut, or in the case of interest, cannot directly reduce. Attempts by DOGE to scale back Social Security customer service spending as well as assistance at veterans’ hospitals were largely abandoned in the face of a steep backlash. Even much of the remaining one-third of federal spending consists of programs that Trump voters generally support, such as infrastructure, border security, farm subsidies, and law enforcement. Ultimately, DOGE was left to slash cultural totems that benefit MAGA enemies: aid to Africa, DEI contracts, Politico subscriptions, and government employees. And while the potential savings from these expenditures look like a lot of money for a typical family, they represent budget dust in the context of a $7 trillion federal budget.

Because real waste exists in the federal budget, DOGE represents a colossal missed opportunity. After all, Washington has a moral obligation to eliminate unnecessary and wasteful spending in order to minimize the necessary cuts to priority programs. OMB estimates that $191 billion annually is lost to payment errors, which overwhelmingly take place within Medicare, Medicaid, unemployment insurance, and earned income tax credit payments. Moreover, Washington is plagued with dozens of overlapping programs in areas such as education, economic development, and job training. And the Defense Department has a long record of losing tens of billions of dollars in contract cost overruns.

These examples of wasteful spending are easy to identify yet quite difficult to fix. Cleaning up such waste often involves completely overhauling countless government computer systems, developing new oversight controls (without unduly paralyzing the distribution of legitimate benefits), and coordinating with state governments that share in the administration of key programs. Overhauling these practices across hundreds of federal programs is tedious, complicated, and thankless—which is why it occurs so rarely. Lawmakers will hold hearings and press conferences blasting government waste, yet few are willing to invest significant resources into, for example, reducing Medicaid payment errors. DOGE could have focused on such activities—especially given its leaders’ background in computing technology—yet it seemed to lack the required attention span. Trump and Musk instead prioritized headline-grabbing gimmicks such as demanding a war on “millions” of fraudulent Social Security payments that did not actually exist.

DOGE Failed

Many posts have discussed federal deficits and the federal debt. Like previous efforts to reduce the deficit by cutting "waste, fraud, and abuse," DOGE was a failure.

 Jessie Blaeser at Politico:

The Trump administration’s claim that it is saving billions of dollars through DOGE-related cuts to federal contracts is drastically exaggerated, according to a new POLITICO analysis of public data and federal spending records.

Through July, DOGE said it has saved taxpayers $52.8 billion by canceling contracts, but of the $32.7 billion in actual claimed contract savings that POLITICO could verify, DOGE’s savings over that period were closer to $1.4 billion.

Despite the administration’s claims, not a single one of those 1.4 billion dollars will lower the federal deficit unless Congress steps in. Instead, the money has been returned to agencies mandated by law to spend it.

DOGE’s latest figures on contract cuts ticked up to $54.2 billion in an update posted on Tuesday.

POLITICO’s findings come on top of months of scrutiny of DOGE’s accounting, but the magnitude of DOGE’s inflated savings claims has not been clear until now.

David Lawder at Reuters:

 The U.S. government's budget deficit grew nearly 20% in July to $291 billion despite a nearly $21 billion jump in customs duty collections from President Donald Trump's tariffs, with outlays growing faster than receipts, the Treasury Department said on Tuesday.

The deficit for July was up 19%, or $47 billion, from July 2024. Receipts for the month grew 2%, or $8 billion, to $338 billion, while outlays jumped 10%, or $56 billion, to $630 billion, a record high for the month.

Waste, Fraud, Abuse

Many posts have discussed federal deficits and the federal debt. Americans vastly overestimate the amount of waste in the budget

Former DOGE employee Sahil Lavingia spoke to NPR:

I did not find the federal government to be rife with waste, fraud and abuse. I was expecting some more easy wins. I was hoping for opportunity to cut waste, fraud and abuse. And I do believe that there is a lot of waste. There's minimal amounts of fraud. And abuse, to me, feels relatively nonexistent. And the reason is — I think we have a bias as people coming from the tech industry where we worked at companies, you know, such as Google, Facebook, these companies that have plenty of money, are funded by investors and have lots of people kind of sitting around doing nothing.

The government has been under sort of a magnifying glass for decades. And so I think, generally, I personally was pretty surprised, actually, at how efficient the government was. This isn't to say that it can't be made more efficient — elimination of paper, elimination of faxing — but these aren't necessarily fraud, waste and abuse. These are just rooms to modernize and improve the U.S. federal government into the 21st century.

The DOGE Debacle

Many posts have discussed federal deficits and the federal debt.

 Elizabeth Williamson at NYT:

President Trump and Elon Musk promised taxpayers big savings, maybe even a “DOGE dividend” check in their mailboxes, when the Department of Government Efficiency was let loose on the federal government. Now, as he prepares to step back from his presidential assignment to cut bureaucratic fat, Mr. Musk has said without providing details that DOGE is likely to save taxpayers only $150 billion.

That is about 15 percent of the $1 trillion he pledged to save, less than 8 percent of the $2 trillion in savings he had originally promised and a fraction of the nearly $7 trillion the federal government spent in the 2024 fiscal year.

The errors and obfuscations underlying DOGE’s claims of savings are well documented. Less known are the costs Mr. Musk incurred by taking what Mr. Trump called a “hatchet” to government and the resulting firings, agency lockouts and building seizures that mostly wound up in court.

The Partnership for Public Service, a nonprofit organization that studies the federal work force, has used budget figures to produce a rough estimate that firings, re-hirings, lost productivity and paid leave of thousands of workers will cost upward of $135 billion this fiscal year. At the Internal Revenue Service, a DOGE-driven exodus of 22,000 employees would cost about $8.5 billion in revenue in 2026 alone, according to figures from the Budget Lab at Yale University. The total number of departures is expected to be as many as 32,000.

Neither of these estimates includes the cost to taxpayers of defending DOGE’s moves in court. Of about 200 lawsuits and appeals related to Mr. Trump’s agenda, at least 30 implicate the department.

“Not only is Musk vastly overinflating the money he has saved, he is not accounting for the exponentially larger waste that he is creating,” said Max Stier, the chief executive of the Partnership for Public Service. “He’s inflicted these costs on the American people, who will pay them for many years to come.”

 

DOGE: Flailing, Failing

 Many posts have discussed federal deficits and the federal debt.

David A. Fahrenthold and Jeremy Singer-Vine at NYT:

Last week, Elon Musk indicated for the first time that his Department of Government Efficiency was falling short of its goal.

He previously said his powerful budget-cutting team could reduce the next fiscal year’s federal budget by $1 trillion, and do it by Sept. 30, the end of the current fiscal year. Instead, in a cabinet meeting on Thursday, Mr. Musk said that he anticipated the group would save about $150 billion, 85 percent less than its objective.

Even that figure may be too high, according to a New York Times analysis of DOGE’s claims.

That’s because, when Mr. Musk’s group tallies up its savings so far, it inflates its progress by including billion-dollar errors, by counting spending that will not happen in the next fiscal year — and by making guesses about spending that might not happen at all.

One of the group’s largest claims, in fact, involves canceling a contract that did not exist. Although the government says it had merely asked for proposals in that case, and had not settled on a vendor or a price, Mr. Musk’s group ignored that uncertainty and assigned itself a large and very specific amount of credit for canceling it.

It said it had saved exactly $318,310,328.30.

Mr. Musk’s group has now triggered mass firings across the government, and sharp cutbacks in humanitarian aid around the world. Mr. Musk has justified those disruptions with two promises: that the group would be transparent, and that it would achieve budget cuts that others called impossible.

Now, watching the group pare back its aims and puff up its progress, some of its allies have grown doubtful about both.

“They’re just spinning their wheels, citing in many cases overstated or fake savings,” said Romina Boccia, the director of budget and entitlement policy at the libertarian Cato Institute. “What’s most frustrating is that we agree with their goals. But we’re watching them flail at achieving them.”

It Is Hard to Reduce the Debt

Americans vastly overestimate the amount of waste in the budget

Elaine Kamarck at Brookings:

Over time, the federal workforce (full and part time) has shrunk as a percentage of the total U.S. population, from 1.1% in FY 1967 to 0.6% in 2018. In absolute terms, the federal workforce is slightly smaller than it was 50 years ago, even though the U.S. population has increased by two-thirds during that time period.7 Not only are the number of federal employees small compared to the population, but they also don’t cost very much. Compensation for federal employees cost $291 billion in 2019, or 6.6% of that year’s total spending.8

Jim VandeHei and Mike Allen at Axios:

President Trump, Elon Musk, and their band of DOGE budget-cutters celebrate daily, even hourly targets to cut U.S. spending on everything from foreign aid to FAA personnel.Trump himself has teased a balanced budget — an impossibility without historic cuts to America's most popular programs, such as Social Security.

Why it matters: Their proposed cuts are but drips of water in America's overflowing bucket of debt — $36 trillion and counting. In fact, most days, America racks up more interest on its debt — $3 billion per day! — than DOGE can find in savings. That leaky bucket is the reality of your nation's finances.

This column is our attempt to clinically outline the facts about deficits — and efforts to reduce or eliminate them.

The big picture: Trump and Musk are correct that America is drowning in deficits. Some of it flows from silly spending on stale or even stupid programs. Those make for terrific X dunking: Agencies with more software licenses than employees! A $324,671 USDA grant for "Increasing DEIA Programming for Integrated Pest Management"! A $3 million Education Department contract "to write a report that showed that prior reports were not utilized by schools"!

But trimming fat is harder than it looks: 37% of the contract terminations on an initial list on DOGE's "Wall of Receipts" (417 out of 1,125) weren't expected to save any money, usually because it had already been spent.

And the only way to truly reduce the deficit is to target the very programs Trump refuses to touch — defense, Medicare, Medicaid and Social Security. They account for 86% of the budget.

Federal Headcount

 

Musk and Ramaswamy promise "mass head count reductions" across the federal government in a new WSJ op-ed.

They say they want to finish their work by July 4, 2026.

[Keep in mind the federal gov't headcount peaked in the 1990s] pic.twitter.com/kZT3FRuT4P

— Heather Long (@byHeatherLong) November 20, 2024

Waste Fraud and Abuse!

Americans vastly overestimate the amount of waste in the budget

 Andrew Rudalevige at Good Authority:

Probably the closest quasi-recent parallel is the President’s Private Sector Survey on Cost Control in the Federal Government, convened by Ronald Reagan in 1982. PPSSCCFG was hardly a mellifluous acronym, so the body was usually known as the Grace Commission, after its chair, J. Peter Grace of the W.R. Grace & Co. chemical manufacturing firm. In the end, public administration professor Charles Goodsell later wrote, “some 2,000 business executives, managers, experts and special consultants were brought into the project, probably the biggest army of outside help given the government since World War II.” Goodsell concluded that some of the 2,478 proposals that resulted (after duplicates the number was closer to 2,160) were quite useful. One legacy, arguably, was the federal base closing process adopted in 1988.

But (Goodsell continued) the overall effort was of “decidedly mixed quality” and the amount saved by adopting these proposals fell far short of the $424 billion over three years that Grace himself claimed. Indeed, a joint GAO-CBO analysis put the figure at closer to $98 billion. In 1986, Reagan himself said the U.S. government had accepted 1,741 of the recommendations, but most still required congressional action – which would save just under $70 billion over five years. (At this point the federal budget was about $930 billion, so the savings would have been about 1.4% of each year’s spending.)

The Grace Commission exercise, then, had its analytic uses. But its contribution to cutting the budget deficit was greatly exaggerated. Further – as none other than John Roberts (yes, the current chief justice, then serving in the White House Counsel’s office) noted in two 1985 memos – the “Commission itself presented an unending parade of legal problems.” Indeed, “serious conflict of interest problems were presented … as corporate executives on the Commission scrutinized the internal workings of agencies charged with regulating their businesses.” (And yes, the potential Musk task force raises similar legal concerns – especially since Musk companies have $3 billion in federal contracts, according to the New York Times.)

"The Greatest Infrastructure Failure in the History of Our Country"

Many posts have discussed California's high-speed rail fiasco.

Lee Ohanian at Hoover:

In 2008, California voters approved $9.95 billion of state bond funding as seed money to build an 800-mile high-speed rail (HSR) network connecting Los Angeles and San Francisco, and the Central Valley to coastal cities, at speeds of up to 220 miles per hour, with an expected completion date of 2020.

But now, 15 years after the bond issue, three years after the expected completion date, not one train has left the station. Not one route has been completed, even though nearly all the $9.95 billion seed money has been spent. And the original budget of about $33 billion for the entire 800-mile system is now inadequate to build just one route (Bakersfield to Merced), whose cost pencils out to $207 million per mile—a cost that will almost certainly rise in the future, and for a route that may not be ready for ten years. Or more. Or perhaps ever.

California’s HSR is perhaps the greatest infrastructure failure in the history of the country. And the reason it failed is because of a gross failure of state governance, one on such a grand scale that it is nothing short of a betrayal of Californians.

The Train to Nowhere

 California's "high-speed" rail project is a fiasco.

Ashley Zavala at KCRA-TV:

California's bullet train project that is meant to link Los Angeles to San Francisco faces more cost increases and potential delays, according to an update from project leaders released this week.

High Speed Rail Authority officials on Thursday could not provide an estimated completion date for the original vision pitched to voters but said the price tag for the entire project is now up to $128 billion, a 13% increase from last year's projections.

Construction is currently focused on a segment in the Central Valley, a 170-mile stretch between Bakersfield and Merced. Project officials last year estimated that the route would be ready for riders in 2030. While that is still their goal, the latest update shows service could begin sometime between 2030 and 2033.

The Central Valley segment also faces 41% in cost increases compared to last year's estimates, now expected to cost up to $35.3 billion. Part of the scoping plan changed between this year and last, with this year's estimate including light maintenance facilities and new elements for the station in Bakersfield. Project leaders also pointed to the impacts of COVID-19, inflation and supply chain issues that have raised the prices of labor, concrete and steel.

Crazy Train 2022

California's high-speed rail project is a fiasco -- predictable and predicted.

Ralph Vartabedian at NYT:

Building the nation’s first bullet train, which would connect Los Angeles and San Francisco, was always going to be a formidable technical challenge, pushing through the steep mountains and treacherous seismic faults of Southern California with a series of long tunnels and towering viaducts.

But the design for the nation’s most ambitious infrastructure project was never based on the easiest or most direct route. Instead, the train’s path out of Los Angeles was diverted across a second mountain range to the rapidly growing suburbs of the Mojave Desert — a route whose most salient advantage appeared to be that it ran through the district of a powerful Los Angeles county supervisor.

The dogleg through the desert was only one of several times over the years when the project fell victim to political forces that have added billions of dollars in costs and called into question whether the project can ever be finished.

Now, as the nation embarks on a historic, $1 trillion infrastructure building spree, the tortured effort to build the country’s first high-speed rail system is a case study in how ambitious public works projects can become perilously encumbered by political compromise, unrealistic cost estimates, flawed engineering and a determination to persist on projects that have become, like the crippled financial institutions of 2008, too big to fail.

Government Pays $1.4 Billion to Dead People

There have been problems with efforts to stimulate the economy in the wake of the coronavirus recession.

From the Government Accountability Office:

Economic impact payments. The Internal Revenue Service (IRS) and the Treasury moved quickly to disburse 160.4 million payments worth $269 billion. The agencies faced difficulties delivering payments to some individuals, and faced additional risks related to making improper payments to ineligible individuals, such as decedents, and fraud. For example, according to the Treasury Inspector General for Tax Administration, as of April 30, almost 1.1 million payments totaling nearly $1.4 billion had gone to decedents. GAO recommends that IRS should consider cost-effective options for notifying ineligible recipients how to return payments. IRS agreed with the recommendation.

Bad Accounting at the Pentagon

Scot J. Paltrow reports at Reuters:

The United States Army’s finances are so jumbled it had to make trillions of dollars of improper accounting adjustments to create an illusion that its books are balanced.

The Defense Department’s Inspector General, in a June report, said the Army made $2.8 trillion in wrongful adjustments to accounting entries in one quarter alone in 2015, and $6.5 trillion for the year. Yet the Army lacked receipts and invoices to support those numbers or simply made them up.

As a result, the Army’s financial statements for 2015 were “materially misstated,” the report concluded. The “forced” adjustments rendered the statements useless because “DoD and Army managers could not rely on the data in their accounting systems when making management and resource decisions.”

Disclosure of the Army’s manipulation of numbers is the latest example of the severe accounting problems plaguing the Defense Department for decades.

The report affirms a 2013 Reuters series revealing how the Defense Department falsified accounting on a large scale as it scrambled to close its books. As a result, there has been no way to know how the Defense Department – far and away the biggest chunk of Congress’ annual budget – spends the public’s money.

Crazy Train Update

Ralph Vartabedian reports at The Los Angeles Times:

The monumental task of building California's bullet train will require punching 36 miles of tunnels through the geologically complex mountains north of Los Angeles.

Crews will have to cross the tectonic boundary that separates the North American and Pacific plates, boring through a jumble of fractured rock formations and a maze of earthquake faults, some of which are not mapped.

It will be the most ambitious tunneling project in the nation's history.

State officials say the tunnels will be finished by 2022 — along with 300 miles of track, dozens of bridges or viaducts, high-voltage electrical systems, a maintenance plant and as many as six stations. Doing so will meet a commitment to begin carrying passengers between Burbank and Merced in the first phase of the $68-billion high-speed rail link between Los Angeles and San Francisco.

However, a Times analysis of project documents, as well as interviews with scientists, engineers and construction experts, indicates that the deadline and budget targets will almost certainly be missed — and that the state has underestimated the challenges ahead, particularly completing the tunneling on time.

...

But Bent Flyvbjerg, a University of Oxford business professor and a leading expert on megaproject risk, said the lagging schedule, litigation, growing costs and permit delays arising so early in construction are warning signs that even more delays and higher costs are coming.

"You have an 80% to 90% probability of a cost overrun on a project like this," Flyvbjerg said. "Once cost increases start, they are likely to continue."

Flyvbjerg's research found that high-speed rail projects around the world experience an average of 45% cost growth, though 100% increases occur in some cases.

Although the state hopes to correct some of its early setbacks, the odds are stacked high against it, said Robert Bea, a member of the National Academy of Engineering and a pioneer in civil engineering risk analysis.

"You can never make up an early cost increase," Bea said. "It just gets worse. I have never seen it go the other way in 60 years."

Recycling: Costs and Benefits

John Tierney writes at The New York Times that many supporters of recycling have little ideas of its environmental costs and benefits.

But how much difference does it make? Here’s some perspective: To offset the greenhouse impact of one passenger’s round-trip flight between New York and London, you’d have to recycle roughly 40,000 plastic bottles, assuming you fly coach. If you sit in business- or first-class, where each passenger takes up more space, it could be more like 100,000.

Even those statistics might be misleading. New York and other cities instruct people to rinse the bottles before putting them in the recycling bin, but the E.P.A.’s life-cycle calculation doesn’t take that water into account. That single omission can make a big difference, according to Chris Goodall, the author of “How to Live a Low-Carbon Life.” Mr. Goodall calculates that if you wash plastic in water that was heated by coal-derived electricity, then the net effect of your recycling could be more carbon in the atmosphere.

...

The national rate of recycling rose during the 1990s to 25 percent, meeting the goal set by an E.P.A. official, J. Winston Porter. He advised state officials that no more than about 35 percent of the nation’s trash was worth recycling, but some ignored him and set goals of 50 percent and higher. Most of those goals were never met and the national rate has been stuck around 34 percent in recent years.

“It makes sense to recycle commercial cardboard and some paper, as well as selected metals and plastics,” he says. “But other materials rarely make sense, including food waste and other compostables. The zero-waste goal makes no sense at all — it’s very expensive with almost no real environmental benefit.”

One of the original goals of the recycling movement was to avert a supposed crisis because there was no room left in the nation’s landfills. But that media-inspired fear was never realistic in a country with so much open space. In reporting the 1996 article I found that all the trash generated by Americans for the next 1,000 years would fit on one-tenth of 1 percent of the land available for grazing. And that tiny amount of land wouldn’t be lost forever, because landfills are typically covered with grass and converted to parkland, like the Freshkills Park being created on Staten Island. The United States Open tennis tournament is played on the site of an old landfill — and one that never had the linings and other environmental safeguards required today.

Social Security Disability Overpayments

Social Security's inspector general has reported on disability overpayments. The summary:

Our review of 1,532 beneficiaries in current pay status as of October 2003 found that over a 10-year period (from October 2003 through February 2014), SSA assessed overpayments for 44.5 percent of sampled beneficiaries. Based on the sample, we estimated 

• SSA assessed overpayments totaling about $16.8 billion between October 2003 and February 2014 for approximately 4 million beneficiaries who were in current payment status in October 2003;

•  SSA recovered about $8.1 billion of the $16.8 billion in overpayments it assessed; and

• SSA prevented about $8 billion in overpayments between October 2003 and February 2014 to approximately 1 million beneficiaries in current pay status in October 2003 by suspending monthly payments.

Additionally, the overpayment rate in Fiscal Year 2004 was 3.1 percent of all benefits paid that year. SSA reviewed the draft report and provided technical comments regarding unavoidable overpayments related to medical improvement, which we incorporated into the body of this report.

Opinion on Government Waste

Gallup reports:

Americans estimate that the federal government wastes 51 cents of each tax dollar. This matches their prior estimate in 2011, which was the highest Gallup had measured since 1979. Americans are less harsh about their state and local governments, viewing them as wasting 42 cents and 37 cents, respectively.

When Gallup first asked the question in 1979, Americans estimated that the federal government wasted 40 cents of every dollar, their state government wasted 31 cents, and their local government wasted 25 cents. Those are the lowest figures for state and local levels of government in any year since, while the lowest waste estimate for federal spending was a slightly lower 38 cents in a 1986 survey.

Gallup didn't ask these questions during the next decade, but when it next asked them in 2001, the "wasted cents" estimates were roughly in line with those in the 1980s. Since 2001, however, the proportion of the tax dollar Americans say the federal and state governments waste has increased, while the estimate for local governments has remained roughly the same.

Americans historically have always seen local governments as wasting the lowest proportion of each dollar, while seeing the federal government as wasting the most. This is consistent with Gallup research showing that Americans' trust in state and local governments is significantly higher than their trust in the executive and legislative branches of the federal government.

The Wheelchair Scam

At The Washington Post, David A. Farenthold writes about a scam that hit Medicare:

The wheelchair scam was designed to exploit blind spots in Medicare, which often pays insurance claims without checking them first. Criminals disguised themselves as medical-supply companies. They ginned up bogus bills, saying they’d provided expensive wheelchairs to Medicare patients — who, in reality, didn’t need wheelchairs at all. Then the scammers asked Medicare to pay them back, so they could pocket the huge markup that the government paid on each chair.

A lot of the time, Medicare was fooled. The government paid.

Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and “scooters” for 2.7 million people. Today, the government cannot even guess at how much of that money was paid out to scammers.

Now, the golden age of the wheelchair scam is probably over.

But, while it lasted, the scam illuminated a critical failure point in the federal bureaucracy: Medicare’s weak defenses against fraud. The government knew how the wheelchair scheme worked in 1998. But it wasn’t until 15 years later that officials finally did enough to significantly curb the practice.

...

Today, even while the wheelchair scam is in decline, that same “pay and chase” system is allowing other variants of the Medicare equipment scam to thrive.

They aren’t perfect. But they work. In Brooklyn, for instance, the next big thing is shoe inserts. Scammers bill Medicare for a $500 custom-made orthotic, according to investigators. They give the patient a $30 Dr. Scholl’s.

In Puerto Rico, the next big thing seems to be arms and legs.

In one case there, two dozen companies billed Medicare for $5.3 million in prosthetic legs inside of a year. In many cases, their “patients” had no record of amputations in their medical history. Many of them didn’t even live in Puerto Rico. But Medicare paid for the legs.

 

Distrust

Previous posts have discussed public distrust of government.  Reason reports:

Americans don’t paint a pretty picture of their public servants in the new national Reason-Rupe poll. Americans tell Reason-Rupe that 75 percent of all politicians are “corrupted” by campaign donations and lobbyists. And they say 70 percent of politicians use their political power to help their friends and hurt their enemies.

...

Asked, which is a “more serious” problem — “special interest groups spending private money on campaigns to elect the politicians they favor” or “elected officials enacting policies and spending taxpayer money that benefit the special interests they favor” — 63 percent of Americans said officials enacting policies and spending taxpayer money for special interests was a more serious problem.

Similarly, Americans say they are “more bothered” by politicians abusing political power than they are by some of the personal issues most often associated with political downfalls. Seventy percent of Americans say they would be “most bothered” by a politician who used his or her political power to bully someone, while 14 percent would be most bothered by a politician using drugs, and 11 percent would be most bothered by a politician who cheated on his/her spouse.

The Reason-Rupe national poll conducted live interviews with 1,003 Americans on mobile (503) and landline (500) phones from March 26-30, 2014. The margin of error is plus or minus 3.6 percent. Princeton Survey Research Associates International executed the nationwide Reason-Rupe survey.

...
Americans may trust the IRS more than Facebook, but with the April 15 deadline for filing federal income tax returns approaching, they’re reminded of how much money they send to the government. Asked open-ended how much of every tax dollar is wasted, the median answer was half, 50 cents.