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Originally Posted by Villages Kahuna
Question One Redux:
Thanks for the legal reference, Steve. I guess I would re-phrase my question to be "If Medicare fraud is so rampant, how come so few doctors and other providers are prosecuted under 18 USC Section 1035?" (There may be some, but very, very few such prosecutions are ever reported on, leaving me to believe that only the most egregious and high profile cases lead to action by the U.S. Attorney.)
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It's strictly a matter of assets and training. "White collar crime" like this requires investigators skilled in this kind of investigation, and the time to do it. These investigations can take many months and years, and the federal agencies which play in this arena (FBI, DEA to a degree, HHS/SSA IG, US Attorney's Office, and a couple others) have higher priority targets for the finite resources they have. As none of the health care plans proposed so far add any resources to the Department of Justice or HHS for such law enforcement efforts, what there is now is all there is.....
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Originally Posted by Villages Kahuna
I shared my feelings on tort reform and fraud prevention with a doctor friend of mine. He is a semi-retired emergency room physician, still practicing in The Villages area. Here's what he had to say...
"Tort reform would help eventually but not a great deal and then only very slowly. The amount of cover-your-ass tests and procedures would eventually be cut and smarter practice would result after a while. While it would be very welcome, the actual amount saved would not be that great.
Fraud detection could save big bucks and do it fairly quickly but would involve government (either Medicare itself or the U.S. Attorney investigators) looking into billing and using statistical snooping techniques to audit charges, etc. It could be done in a legal and appropriate way and SHOULD be done regardless of any reform changes."
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Changing a "business culture" is not the easiest of things to accomplish. Your friend understands this well. Whether any change occurs or not will basically require a new generation not already prejudiced by how things are currently done and how they have learned to conduct their business. In the meantime, it's the patients who absorb all the risk - not the insurance companies, practitioners or the lawyers and the courts.
And again, unless Congress funds the Department of Justice and others with more assets dedicated to Medicare malfeasance, what's being done now is all there is.....