Skip to comments.Applying health care research to the problem of health care fraud
Posted on 09/21/2013 10:20:22 AM PDT by grumpygresh
...U.S. Department of Health and Human Services, and the Department of Justice (DOJ), including the FBI. Working together, these agencies audit health care providers, review claims and prosecute fraudulent parties using an approach known as pay and chasetrying to recover money paid out for fraudulent claims rather than denying the claims in the first placewhich a 2012 report by the U.S. Government Accountability Office (GAO), cited by the authors, called ineffective. Less than $20 million of the $102 million spent on audits from 2008 to 2012 was recovered, according to a June report by the GAO... Overall, however, Dr. Goodwin said forensic health services research is a good idea. The distinction between fraud and abuse can be debated endlessly, but there is no doubt that using administrative data to identify clinics and providers with abuse-like profiles for further scrutiny could have a major impact on overuse of tests, procedures and treatments.
(Excerpt) Read more at m.anesthesiologynews.com ...
It has long been the policy of CMS to make a felon out of each and every doctor.