Doctor Police? Have the Feds lost their mind?

Wisconsin can do better…

By Jack E. Lohman

Yes, we have medical providers and doctors that over-bill, or up-code (provide a low-level service but bill for a higher reimbursement code), and still others that fraudulently bill Medicare for services not even provided. They do it from their garage.

So the Republicans have suggested — and Obama has accepted — the stupid idea of establishing a new department of federal agents to sniff these out by pretending to be a patient and visiting unsuspecting doctors.

This is inefficient and ineffective, but nobody has ever accused the government of being smart. Some of these fraudulent billers are not even doctors, so whom would these agents visit? The garage? Some of these fraudulent billings originate from nursing homes where they put a patient in front of a TV set and bill for a therapy session. Or with a group of patients in front of the TV, and bill for group therapy. So do we admit these agents into nursing homes as spies?

Dumb, dumb, dumb…

The best way to eliminate these fraudulent billings is also the least costly. They should simply strengthen the whistleblower laws and require all Medicare providers to educate all employees, both new and old, on what Medicare fraud is and how to report it and their rewards for doing so. Report it first to management and if it does not stop, report it to Medicare and collect your reward.

The savings will come from deterrence. No hospital or clinic or nursing home CEO or physician in his right mind would ever allow fraud to begin with this employee oversight and reward system.

  1. Stop the fraudulent practices altogether by allowing the employees to become the eyes and ears, free of charge to the taxpayers.
  2. Deter it! Stop it before it occurs; not after!
  3. Eliminate the costly trials trying to get the taxpayer money back and the perps jailed.
  4. Eliminate the costly incarcerations that otherwise would have resulted.
  5. Eliminate the costly government department of undercover agents.

Can you imagine the savings to the government? President Obama, are you listening?

Are the private insurers safe?

No, government fraud is not alone in this. Defrauding private insurers and over-utilization rates are usually higher because (a) the privates don’t have as strict a fee schedule and (b) jail time is less of a concern. So private insurance rates should come down if this deterrent is put in place.

So where is the political money flow?

Well, there wouldn’t be. Hard to believe, but total taxpayer savings. Unless, of course, congress chooses to privatize the agents to a security company that kicks back bribes in the form of campaign contributions.

Nah, that’d never happen.  🙂

7 Responses to Doctor Police? Have the Feds lost their mind?

  1. This is one of the best ideas against fraud I’ve seen, and simple. This is going to bother me now when I see government going after fraud cases.

    It’s just too easy.

  2. Yea, but just think about the new (government) jobs that will now be created (at taxpayer expense, I might add).

  3. Jack – No doubt that strengthening the whistler rules would help – but I’m guessing you’ve never worked around nurses. The fact is the climate of intimidation & fear that exists in the clinical setting means precious few physician shenanigans ever get reported. Strengthening the ‘whistle’ would make but a micro-dent in the stunning volume of doctor-related crime. Very few people are willing to put themselves in the middle of a lawsuit with their own bosses – and they could starve while waiting for a trial with no guarantees. Two nurses in Texas recently reported an MD to the state, and found THEMSELVES on trial. You might want to ask them if they’d go through that again. The smaller the town, the worse the outcome, even if you are acquitted.

    The ‘secret shopper idea’ could be effective if well-implemented. One thing is for sure: Physician-related crime is rampant and – according to the U.S. DOJ – it costs 1/2 trillion a year to combat. We all know that money could be better spent.

    2,490 doctors were convicted of crime in ’09 alone – 11,000 in the last decade. It’s time to get creative, because it ain’t gonna get better by itself. Health Care Reform? Why don’t we just start by tossing out the lunatics, and not re-license doctors who rape, run drugs, steal from Medicare, perform unnecessary surgeries for wealth & murderers?

  4. […] doughnut hole over 10 years? Why not kill it today? Why hire undercover cops to sift for fraud when strengthening the whistle-blower laws will do it at zero cost to the taxpayers? Why hire more IRS agents when the people not paying for […]

  5. Thanks for the comment, Patrick, and an excellent web site you have. (Click on his name to reach his site.)

    Indeed all industries have bad apples, and you’ve noted them well. What were the two Texas nurses charged with?

    And yea, I employed nurses in my cardiac monitoring company, which I sold when I retired over six years ago. And for 25 years I suffered through their quirks. 🙂

    The whistle-blower recommendation is to serve as a deterrent to crime. Stop it before it gets started. All medical providers have turnover, and it is when the employee terminates that the provider must worry about getting turned in. Thus few physicians and providers will take the chance of getting turned in, knowing that any one of his employees could do so, and billing crimes will go down significantly.

  6. […] we just fix it right, once and for all, and then move on to fixing our economy? No new IRS agents, no new FBI agents, let’s use the infrastructure already in place… Medicare. And save $400 billion in the […]

  7. The new health care reform law includes some whistle-blower protections.

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