Is Government Committed to Solving Healthcare Fraud – Or Not?
By Mike Shultz, Infoglide Software CEO
Last week Rep. Scott Murphy of Glen Falls (D-NY) told a House panel that more effective policing of Medicare and Medicaid fraud claims is imperative in order to reduce the estimated $60 billion in fraudulent claims that is disbursed each year. We agree with the expressed intent, and we are hopeful that CMS and others involved in decision-making will take advantage of any and all technologies to stamp out fraud, including identity resolution.
The press has reported repeatedly that both the Medicare (federal) and Medicaid (state) programs are riddled with fraud. Unscrupulous doctors, medical supply firms, and others involved in the healthcare supply chain are able to extract millions up millions of dollars of taxpayer money from these government programs.
A recent example reported by the Miami Herald told how the Miracle Group Rehabilitation Center was “falsely billing the federal healthcare program $3.1 million over just three months. Medicare paid Ramos $1.9 million for rehab services never provided to angry beneficiaries… This past year, CMS paid approximately $60 billion to criminals impersonating doctors and patients in order to file false claims.” Multiply this by the thousands of dishonest people who abuse these systems and you can easily exceed the $60 billion estimate!
So what is being done? The federal government included legislation targeting healthcare fraud in the comprehensive healthcare bill it passed last year. As we’ve reported before, many states are passing legislation as well.
Passing stiffer laws is great, yet we’re certain the information needed to stop most of the fraud is in data already held by government agencies. Honest suppliers stand by helplessly as competitors cash in on the bonanza. One such supplier wrote in a guest post about how current detection methods are inadequate and how the problem can be attacked with the right technology.
It appears to be a matter of educating those in power about existing technology and having the political resolve to apply it. We hope that happens soon.
