KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Experts Call For Greater Crackdown On Medicare Fraud

Efforts to crack down on Medicare fraud heat up while some experts say more should be done.

Reuters reports that the "The Justice Department and Department of Health and Human Services launched a special strike force in Miami in 2007 to combat Medicare fraud in South Florida and similar units have been set up in Los Angeles, Houston and Detroit. But critics say far more is needed in terms of meaningful steps to attack fraud in healthcare, which drains the system of resources and forces up insurance premiums. ... Fighting fraud effectively can seem expensive, especially in economic hard times when state governments are scrambling to plug gaping budget holes."

"But [Peter Budetti, who chairs the Department of Health Administration and Policy at the University of Oklahoma's College of Public Health,] said the benefits far outweigh the costs of detection services such as data mining to root out fake billing scams and forms of fraud."  The federal health agency's Office of the Inspector General documented large numbers of Medicaid and Medicare claims for patients who had died before they were supposedly treated, along with significant numbers of services prescribed by deceased physicians (Brown, 11/25).

Meanwhile, NBC Nightly News did a story using Dartmouth Atlas data to compare average annual Medicare patient costs in various cities.  "Statistics show that in Miami, patients are more likely to spend more time in the hospital and get expensive tests like MRIs." NBC reports there is also "a lot of fraud and abuse" in Miami (Bazell, 11/24).

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