Opinion: When fraud shows up on the Republicans’ radar

Published 9:30 pm Wednesday, April 30, 2025

According to a report by the nonpartisan Congressional Budget Office, with cuts to Social Security and Medicare off the table, the only way to offset the revenue loss from the Republican plan to make the 2017 tax cuts permanent is reduce Medicaid spending by $880 billion over 10 years. Because the federal program covers the healthcare expenses for 40% of Alaskans, that has Sen. Lisa Murkowski worried.

When President Donald Trump was asked about cutting Medicaid that much during an interview last week, he said they’re only “going to look at waste, fraud, and abuse.”

As usual, Murkowski did her homework.

And Trump was shooting from the hip.

The last time he gave gave any real thought to healthcare insurance fraud was the day before he left office in 2021. That’s when he pardoned or commuted the sentences of several health care executives convicted of fraud.

Philip Esformes was one of them. He was sentenced to 20 years in prison for Medicare and Medicaid schemes that cost the taxpayers $1.3 billion.

It’s also worth noting that soon after returning to the White House, Trump fired the inspector general for the Department of Health and Human Services without cause. Christi Grimm had been responsible for overseeing investigations of waste, fraud and abuse. According to court documents, she helped HHS save more than $18 billion during her three-year tenure.

Obviously, fraud is a serious problem for more than HHS programs. The General Accounting Office estimates the annual impact on the entire federal government is between $233 billion and $521 billion.

In an Anchorage Daily News opinion piece two weeks ago, Richard Stern, an acting director at the Heritage Foundation, and Katherine Miller wrote it’s “all squandered due to government incompetence” and “lost to the black hole of government dysfunction.”

“No business could survive losing billions without tracking where it went — they’d go bankrupt overnight. In Washington, though, failure just demands more taxpayer dollars to bury the mess.”

Not once did they mention the perpetrators.

Fraud isn’t just a problem for the government. It impacts dozens of industries in the private sector too. The banking industry tops them all. According to Security.org, last year 62 million Americans were victims of credit card fraud that exceeded $6.2 billion.

However, no one would dare reference that as evidence that bank managers are incompetent.

If congressional Republicans were truly interested in healthcare insurance fraud, they’d fix the Medicare Advantage program they championed back in 1997. Touted as an improvement over the standard government-administered program, it allows Medicare-eligible seniors to choose private insurance policies. But while private insurers manage it, they’re still using taxpayer dollars to pay the bills.

The program allows insurers to add diagnoses codes to those submitted by the doctors when filing claims on behalf of their patients. According to a Wall Street Journal investigative report, the practice known as upcoding resulted in “hundreds of thousands of questionable diagnoses that triggered extra taxpayer-funded payments from 2018 to 2021.” It cost taxpayers an estimated $50 billion.

One example is a 2023 settlement in which The Cigna Group agreed to pay $172 million for allegedly adding inaccurate diagnosis codes to increase Medicare Advantage payments they received.

The No UPCODE Act proposed two years ago by Sens. Bill Cassidy, M.D. (R-La.) and Jeff Merkley (D-Ore.) might have gone a long way to fixing the problem. But the fact their bill never even got a hearing suggests Republicans won’t touch the program.

More evidence of that can be found in the Project 2025 report. It recommends making Medicare Advantage “the default enrollment option” and removing “burdensome policies that micromanage” its plans. In fact, in their three-page narrative about reforming Medicare, the bullet point “Reduce waste, fraud, and abuse” is the only time fraud is mentioned.

The Heritage Foundation was one of the main funders of Project 2025. Russell Vought, Trump’s director of the Office of Management and Budget was a co-author. Several other members of his administration contributed to it.

As so transparently displayed in the opinion by Stern and Miller, for them and many Republicans, complaining about fraud is intended to sow mistrust in the government. And a means to their goal of downsizing or eliminating social programs like Medicaid that they despise.

• Rich Moniak is a Juneau resident and retired civil engineer with more than 25 years of experience working in the public sector. Columns, My Turns and Letters to the Editor represent the view of the author, not the view of the Juneau Empire. Have something to say? Here’s how to submit a My Turn or letter.