Rampant Medicare Frauds – A Serious Call for Clarity in Regulations

  • Date: March 09, 2010
  • Source: admin
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Opined by the keynote presenter of HIMSS 2010, Harry Markopolos, every year at least 20 percent of the current Medicare payments are going to fraudulent claims in US. Harry Markopolos, who is celebrated for exposing the ponzi scheme of Bernard Madoff, believes that health information technology is a double-edged sword in terms of finding fraud. He says “The EHR can make fraud easier to find, but also makes it easier to camouflage."  

However, according to Uwe Reinhardt, professor of economics in Princeton University, fraudulent Medicare claims are not deliberate; in fact they result from confusing administrative system. He firmly believes that "[T]he regulations surrounding the rendering of health care services to the federal government are immensely complex,". He again affirms his believe that "They seem to be based on the idea that every provider of these services is a latent crook. Other countries manage the process by exception. They go by the assumption that the bulk of providers of care are honest and then merely go after the statistical outliers. Far less money is spent on billing in those countries." 

His advice to the US government in order to curb the growing administrative cost of American healthcare is “[t]hey might commission a study exploring how government-run health systems in other nations manage to pay hospitals and doctors without imposing on them the huge administrative burden borne by American providers of health care,…Perhaps Congress can learn from such a study." He strongly believes that only clear regulations together with a more measured and thought-out approach can fight fraud and result into less fraud in the US health care industry.



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