The Federal government in February charged 111 individuals with fraud in its largest-ever healthcare fraud action, alleging more than $225 million in false billing. This latest haul by the Medicare Fraud Strike Force has been proposed as an important step toward trimming the Medicare budget and freeing up funds for healthcare reform. To underscore the significance of the federal action, five authorities made the announcement: Attorney General Eric Holder, Health and Human Services (HHS) Secretary Kathleen Sebelius, FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer, and HHS Inspector General Daniel Levinson. DOJ and HHS also announced that Medicare Fraud Strike Force operations are expanding to include Dallas and Chicago.
The agencies' “clear message,” according to Mr. Levinson, is “we will not tolerate criminals lining their pockets at the expense of Medicare patients and taxpayers.” Targeting blatant criminals who steal taxpayer funds is surely a worthy endeavor. But perhaps the recent spate of crackdowns should send a message to regulators, too. If nabbing 111 fraudsters can uncover $225 million in false claims, why do CMS and the OIG spend so much time distressing physicians with warnings about all the minor errors that can be construed as “fraud,” including undercoding? If a few individuals can amass so much money through fraudulent billing, then musn't the onerous requirements of billing and documentation—which require neurologists to spend copious amounts of time and invest in personnel—be inefficient?
The agencies involved in policing Medicare fraud acknowledge that the vast majority of physicians are honest and ethical. Of course, there must be safeguards to ensure appropriate Medicare billing and encourage those who might stray to remain honest. But it sometimes seems like the government assumes that billers are dishonest and must prove otherwise; That's interesting, given that the HHS statement on the arrests includes a disclaimer that the accused are innocent until proven guilty.
The rolls of Medicare are larger than ever and expected to grow dramatically in coming years. Unlike some other specialties, neurologists don't have numerous options to implement a fee-for-service model—although opportunities exist. The government must continue its successful efforts to bring Medicare abusers to justice, but it should also avoid imposing any new requirements on care providers and consider decreasing the burden on clinicians who could better spend their time treating patients than coding.