Like other candidates, Ben Carson's approach to fraud is long on talk, short on action

Presidential candidate and noted neurosurgeon Ben Carson is grappling with how to handle healthcare fraud. By all appearances, he is losing that battle to himself.

Carson's approach to reducing fraud is certainly unique. In his book "America the Beautiful," published in 2013, Carson advocated for a no-nonsense approach to fraud, similar to the way theft is punished in Saudi Arabia.

Well, almost.

"Why don't people steal very often in Saudi Arabia?" he wrote. "Obviously because the punishment is the amputation of one or more fingers. I would not advocate chopping off people's limbs, but there would be some very stiff penalties for this kind of fraud, such as loss of one's medical license for life, no less than 10 years in prison and loss of all of one's personal possessions."

So you won't lose your pinky finger if you commit fraud--but all your personal possessions? Sounds like someone who wants to get tough on fraud. However, as Mother Jones pointed out recently, that approach wouldn't apply if you're one of Carson's good friends, such as convicted fraudster Alfonso Costa.

In September 2007, Costa, an oral surgeon, pleaded guilty to one count of healthcare fraud for overbilling $44,000 in dental work surgeries, including one instance in which he billed for the extraction of four impacted molars rather than two. Prosecutors claimed that, all told, Costa submitted roughly 50 fraudulent bills to seven companies over five years.

Costa didn't even get the maximum sentence of 18 months. Instead he was sentenced to three years of probation, including one year of house arrest.

You see, Costa just so happens to be friends with Carson. Best friends, actually. Willing to push aside his Saudi Arabian approach, Carson wrote a letter to U.S. District Judge Gary L. Lancaster who was presiding over the sentencing, asking him to show leniency toward Costa, according to investigations by Mother Jones and the Associated Press. (Costa was good at making friends in high places, apparently, as Pittsburgh Steelers running back Jerome Bettis also wrote a letter to the judge, advocating for leniency in the sentencing.)

"Al Costa is my very best friend," Carson said in a statement. "I know his heart. I am proud to call him my friend. I have always and will continue to stand by him. That is what real friends do!"

Of course, Costa happened to own a real estate development firm that netted Carson as much as $2 million, but I'm sure that had nothing to do with it.

Given the inconsistencies raised about Carson's past, his relationship with Costa may be the least of anyone's worries, but it certainly speaks to the tough-talk approach that politicians often have when discussing healthcare fraud--without offering many viable solutions.

Truth be told, Carson seems shockingly unaware of the true extent of healthcare fraud. In a recent interview with the Miami Herald, for example, he cited healthcare fraud numbers at "half a trillion dollars," which represents more than half of Medicare and Medicaid spending.

But look at Carson's counterparts. They all speak grimly about the problems caused by Medicare and Medicaid fraud, shaking their fists at the wastefulness of government programs, but real solutions are few and far between.

In an interview with Iowa Public Radio, Carly Fiornia was adamant about her stance that every healthcare provider should be required to regularly publish "their costs, their prices, their outcomes" in an effort achieve "complete transparency as well as accountability" as a pathway to fraud prevention. What's a little less clear is how price transparency will prevent fraud.

In a recent news conference, Donald Trump attacked Carson's plan do away with Medicare, calling the program a "horrible thing to get rid of."

"It actually works," Trump said. "You get rid of the fraud, waste and abuse--it works." Unfortunately, he didn't expound on any real plans to get rid of the fraud, waste and abuse.

Mike Huckabee wants to keep Medicare, but notes that 20 percent of the program's spending goes to fraud, waste and abuse. He boldly declares that "we must protect Medicare and prosecute fraud," but fails to specify how he plans to do so.

At the same time, most Republican candidates want to repeal the Affordable Care Act, apparently ignoring the fact that it provided tough new sentencing guidelines for fraudsters that steal more than $1 million, enhanced screening of providers who pose a high risk for fraud and abuse and sunk an additional $350 million in anti-fraud funding.

The law also pushed the Centers for Medicare & Medicaid Services into the 21st century of fraud prevention, requiring the agency to invest in the electronic Fraud Prevention System, which has prevented $820 million in improper medical payments in three years. All together, these measures have led to $10.7 billion in fraud recoveries during the last three years, according to the Department of Health and Human Services. Would repealing the ACA also do away with these anti-fraud measures?

Carson has every reason to be mocked for his hypocrisy when it comes to anti-fraud enforcement. On the other hand, despite the continuous calls to cut down on fraud and abuse within government health programs, we haven't seen a lot of viable solutions from most of his presidential candidate counterparts. - Evan (@HealthPayer)