PRESCRIPTION FOR FRAUD Healthcare providers are learning new and improved ways to rip off taxpayers without getting caught, according to a new government report.
Fraud Costs Americans Billions While Govt Does Nothing
Taxpayers for Common Sense is the best organization that monitors excessive government spending, corruption and corporate welfare. Here is their latest news update.
A General Accounting Office (GAO) report says that while most healthcare consultants provide a legal service by helping providers navigate the complex world of Medicare and Medicaid regulations, some are holding conferences that serve as a how-to for defrauding insurance companies.
“Consultants are throwing gasoline on the fire with their advice to cheat,” said Sen. Chuck Grassley (R-IA), who commissioned the report.
Consultants have taught providers several new ways to rip off insurers. These practices include not reporting or refunding overpayments from insurance companies and conducting unnecessary tests so the provider could document a higher level of care than actually needed.
In one case, a consultant urged providers to not return an overpayment discovered during a self-audit because it could bring a government investigation. The consultant also mentioned that instead of refunding the overpayments many practices just “correct” their billing processes so the overpayments appear legitimate in their paperwork.
According to another consultant, providers order unnecessary tests to bilk money from insurers. This practice gives a physician the documentation that supports higher-level care, which brings in even more money.
Physicians are also taught to divide the tests and workup between two visits and have a nonphysician, like a nurse, do the blood work and other basic jobs. Then the provider can see the patient on the second visit and talk about test results and other pertinent information, allowing the provider to bill at a higher rate.
Improper payments in government health programs, such as Medicaid, drain valuable resources hurting taxpayers and beneficiaries. Fraud in the federal Medicare and Medicaid programs cost taxpayers more than $34 billion in 1997. In fiscal year 2000, Medicare alone paid $11.9 billion in improper payments. With national spending on healthcare expected to rise to $2.2 trillion by 2008, the GAO’s report is cause for alarm.
Lawmakers must intensify oversight efforts of conferences and workshops that give advice that increases fraud and abuse to ensure that Americans get the quality healthcare they deserve and taxpayers are not defrauded by unscrupulous providers.
If you would like more information, contact Keith Ashdown at (202)-546-8500 ext. 110
or by email
at firstname.lastname@example.org. TCS is at www.taxpayer.net
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