KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Medical Fraud Creates Unknown Amount Of Waste

Lawmakers seek a reduction in the amount of money lost each year to medical fraud. Meanwhile, two Miami doctors are convicted of Medicare fraud.

NPR reports: "In the midst of the health care debate, there's a point of certainty. Everyone - Democrats and Republicans, liberals and conservatives - would like to see health care fraud wiped out. But no one knows just how much fraud there is, and estimates range from from $60 billion to $600 billion a year lost to medical fraud." This type of fraud takes several forms. Most often, "criminals get a list of patients' names, then create fictitious doctors. They send bills to Medicare or Medicaid or health insurers for services supposedly rendered to these patients. By the time the payers figure out that the doctors they're paying are fictitious and no service was ever rendered, the criminals have closed up shop and moved on."

NPR reports that in May 2009, the Obama administration launched a task force of officials from the Department of Justice and the Department of Health and Human Services to work on this issue. "And the current House health care overhaul bill has a number of anti-fraud provisions. It would provide $100 million a year to fight fraud, increases penalties for perpetrators and would require that hospitals and similar health care providers that don't already have programs to reduce the chances of fraud develop one. But the big question is, how much money could be saved by eliminating fraud?" (Silberner, 8/18). 

Meanwhile, The Miami Herald reports that two Miami-Dade physicians have been found guilty in an HIV-infusion scheme to defraud Medicare: "A Miami-Dade physician pleaded guilty Thursday to participating in a Medicare racket with four other doctors accused of prescribing $19.5 million in obsolete infusion drugs for HIV patients who generally didn't need or receive the therapy" (Weaver, 8/18).

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