Saturday, August 27, 2011


It appears that the Obama administration is getting serious about fraud in the Medicare and Medicaid systems. One official, Peter Budetti, deputy administrator and director for the Centers for Medicare and Medicaid Services' Center for Program Integrity even responded to an Los Angeles Times opinion piece which attacked Medicare's electronic billing system as one just made for the criminals to take advantage of.

Here's a few of his comments from that response:

Since President Obama took office, we have conducted an unprecedented crackdown on those who steal from Medicare, giving law enforcement greater resources, putting more boots on the ground and increasing penalties. In 2010, these efforts recovered a record $4 billion in taxpayer money.

But we're not just prosecuting fraud. We're also taking steps to prevent it. In the past, nearly anyone could fill out a form with the right information and become a Medicare provider. Criminals could set up false clinics, enlist willing accomplices and vulnerable seniors to submit false claims and begin collecting payments they had not earned for care they had not provided.

That's changing.

First, we're paying closer attention to who is signing up in the first place. Now, before you can become a Medicare provider, you have to go through a rigorous third-party review process that will make sure you have the correct licenses and meet all the requirements to bill Medicare. The days when you could just hang a shingle and start billing Medicare are over.

Second, if criminals do get into the system, they're now a lot more likely to get caught. Starting last month, our Centers for Medicare and Medicaid Services have for the first time a comprehensive picture of Medicare claims nationwide. This means that our investigators can see billing patterns in real time and analyze those patterns. They can identify potentially fraudulent claims before they're paid, investigate them and take action quickly. And we are doing this without placing an undue burden on honest providers, allowing them to focus on providing high-quality care to Medicare beneficiaries.
[Emphasis added]

Mr. Budetti makes it clear that the very system attacked as being designed for fraud has itself made it easier to spot fraud. The electronic billing system provides CMS with ongoing, real-time snapshots of its use in much the same way credit card companies use their system to spot unusual credit card usage. He contends that it works to make the entire system more efficient and it also works to highlight suspicious activity.

If the supercommittee really does want to tinker with Medicare/Medicaid, here is one area that might make sense. Make the elimination of fraud from the system a priority and back that priority up with an increase in penalties for the crime and an increase in the budget of the Department of Justice to investigate and prosecute the crime. Rooting out the criminal element from our health care system would be a lovely gift to the country.

It also would represent change we could believe in.

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Blogger ifthethunderdontgetya™³²®© said...

It's hard to believe in change while this goes on.

(Not noted in that story: Rick Scott founded Solantic and 'divested' himself of his stake by selling it to his wife. Solantic is a significant provider of the tests.)

5:16 PM  

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