About A Third Of the President's Reform Proposal is Devoted to Attacking Medicare Fraud: Will It Work?
Posted Feb 23 2010 4:05pm
Looking back at its career, the Disease Management Care Blog suspects at some point or another, it could have been accused of having technically committed Medicare fraud. Not intentionally of course, but the intensity of service, the documentation, the modifiers, the "incidental to's" CPTs, DRG's, ICD-9's and whatever else was used by the billing office was a thicket of coding logic that seemed to get more complex with each passing year.
Which is why the DMCB is turning once again to the President's Health Reform Proposal. Out of the 11 pages, there are three on attacking 'waste fraud and abuse,' and most of it is directed against the fraud part. There are items that pertain to following bad actors with a history of malfeasance (sort of like a Medicare 'no-fly list), background checks, real time as well as wider data sharing among various enforcement agencies, profiling increased penalties and greater enforcement lattitude.
We've heard this before (here and here, for example) and we're supposed to believe this time it's really really going to work. Trust me.....