Gov­ern­ment has dis­mal record in fight against health­care fraud

Modern Healthcare - - COMMENT -

Re­gard­ing the ar­ti­cle “Feds re­cov­ered $2.4 bil­lion in health­care fraud last year” (ModernHealth­, Sept. 28), this claim by the CMS makes for du­bi­ous head­lines be­cause, as they say in le­gal cir­cles and ac­count­ing, it’s de min­imis— aka a “round­ing er­ror.” It’s less than one-half of 1% of the CMS’ Medi­care claims ex­penses. In the mean­time, the feds and former CMS Ad­min­is­tra­tor Dr. Don Ber­wick say fraud, waste and abuse ac­count for 30% of health­care ex­penses. Fraud and abuse in Medi­care and Med­i­caid has been es­ti­mated at 14% of claims, while it’s es­ti­mated at 3% in the com­mer­cial sec­tor. Big fraud should equal big re­cov­ery, but the CMS has a long way to go to match the per­for­mance of the pri­vate sec­tor in root­ing out fraud.

Michael Cadger

Founder and CEO Mon­o­cle Health Data


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