Monday, November 30, 2009

Why Does Health Care Fraud Play A Back Seat To Health Care "Reform?"

Justinian Lane has an insightful post about an issue often ignored in the national health care debate--that health care fraud costs us three times more than the national costs associated with medical malpractice. This caused me to do a bit of my own research, where I found The Department Of Health And Human Services And Department Of Justice Health Care Fraud And Abuse Conrtol Report For The Fiscal Year 2008 (I think the title of this report needs to be a bit longer...) Some mind blowing stats of the Report...

During FY 2008, the Federal Government won or negotiated approximately $1 billion in judgments and settlements2, and it attained additional administrative impositions in health care fraud cases and proceedings. The Medicare Trust Fund received transfers of approximately $1.94 billion during this period as a result of these efforts, as well as those of preceding years, in addition to over $344 million in Federal Medicaid money similarly transferred separately to the Treasury as a result of these efforts. The HCFAC account has returned over $13.1 billion to the Medicare Trust Fund since the inception of the Program in 1997.

Closer to home, an Ohio physician alone was responsible for a fraudulent billing scheme totalling $1.8 million:

An Ohio physician was sentenced to 37 months in prison after pleading guilty to conspiring to engage in a scheme to defraud Medicare and other health care benefit programs by performing medically unnecessary nuclear stress tests that involved injecting nuclear medicine into patients. During the conspiracy, the physician received at least $1.8 million in reimbursement for the medically unnecessary tests. As part of his guilty plea, the physician agreed to give up his medical license, to forfeit more than $1.8 million, and to be permanently excluded from participation in all federal health care programs.

These staggering figures include only the shysters who got caught. If we're talking billions of dollars recovered, it probably represents the tip of the iceberg as to the amount of actual fraud being perpetrated on U.S. taxpayers.

Yet, despite this rampant, continuing fraud, all some politicians want to talk about is limiting patients' right to sue even in cases of legitimate malpractice. Fraud apparently trumps fairness in this goofy debate...

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