ATTACK MEDICAID FRAUD
What part of “do no harm” do doctors who steal from Medicaid not understand?
The $1.9 million (at least) that health care providers in South Carolina inappropriately billed to the state Medicaid agency in 2008 and 2009 could go a long way to helping poor people in need of medical care — especially at a time when there is not enough Medicaid money to start with.
Investigators can expect to find more errant billing and outright fraud. Authorities estimate that 10 percent of Medicare and Medicaid payments nationally are fraudulent.
South Carolina’s efforts to ferret out Medicaid abuse are sadly necessary, but welcome.
To date, efforts have been made to nab the worst offenders. The state, as requested by U.S. Sen. Charles Grassley, R-Iowa, compiled a list of the 10 providers who billed Medicaid for the most money for each of eight prescription drugs during 2008 and 2009.
Thirty-four of the 83 providers who appeared on those lists were investigated by the S.C. Department of Health and Human Services. The state is now investigating 13 more. The crackdown should be sustained and aggressive.
There also is merit in identifying health care providers who defraud the government on a smaller scale. If there are meaningful consequences, their contemporaries will be discouraged from following suit.
Sen. Grassley has introduced legislation, with bipartisan support, that would allow the public and the media to find out how much individual doctors, hospitals and medical equipment suppliers bill for procedures. That is a good idea. The public, justifiably angry at knowing would-be caregivers are using public money to feather their own nests, could become helpful watchdogs. (This week’s stories in The Post and Courier about the value of freedom of information laws illustrate that dynamic ably.)
Another worthy provision in the legislation would require federal and state law-enforcement agencies to share information on Medicaid/Medicare fraud and medical identity theft.
Even better than catching criminals would be stopping fraud before it occurs. Providers filing for Medicaid should be carefully screened up front.
Unfortunately, that might mean honest providers, the vast majority, experience delays in getting paid.
Providers who are guilty of stealing from Medicaid and Medicare should pay hefty fines in addition to repaying the money they stole. The state medical board should give serious consideration to taking the license of doctors who are willing to defraud the taxpayers.
Medicaid and Medicare already impose a huge financial burden on the nation.
Every effort should be made to prevent Medicare theft and to punish those who are soaking the system
2 comments:
I worked in a private behavioral health office office for years. Prior to that I had no experience with insurance I had paid attention to my personal insurance eob. I know enough now to make me sick. The amount of fraud & abuse especially with government funded insurance is way above 10%. I have seen professionals spend more time on cpt code combinations than on the patients issues. If done right the gov programs pay much faster, rejection is not near the problem as private insurance and can net the provider more money. My mother has medicare and I look at her information from any doctor she sees and the same things are being done just different cpt codes. It is so much worse than anyone suspects. The data mining program that everyone thinks is going to ferret out all the sin is not going to put a dent in the problem. The providers were ahead of that and they have their businesses worked out to get around most of those red flags.
Almost the same happens with Medicaid in child welfare except it is far, far worse.
Post a Comment