Government has dismal record in fight against healthcare fraud
Regarding the article “Feds recovered $2.4 billion in healthcare fraud last year” (ModernHealthcare.com, 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.
Founder and CEO Monocle Health Data