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.
- Stop the fraudulent practices altogether by allowing the employees to become the eyes and ears, free of charge to the taxpayers.
- Deter it! Stop it before it occurs; not after!
- Eliminate the costly trials trying to get the taxpayer money back and the perps jailed.
- Eliminate the costly incarcerations that otherwise would have resulted.
- 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. 🙂