Briefs: Medicaid Crackdown May Lead to Persecution

Article excerpt

Few texts can make the U.S. tax code read like a Sidney Sheldon novel.
But the voluminous, insomnia-curing library of federal Medicare and Medicaid regulations certainly falls into that category - giving our tax laws a certain dramatic and simplistic flair by comparison.
Now, our state government wants to hold health care providers' feet to the fire for sometimes tripping up in this paper mine field.
"Authority takes aim at fraud," read the recent headline in the March 11 Daily Oklahoman.
The story detailed the Oklahoma Health Care Authority's efforts to "root out fraud and overpayments in the Medicaid claims system the agency oversees." To do this, the authority even hired an out-of-state firm - HealthWatch Technology - to spearhead the effort.
The authority will shell out almost $500,000 to HealthWatch.
Of course, the action seems entirely reasonable.
Clearly, our federal and state governments - given economic constraints - should pay providers of health services what they are due and nothing more. My concern rests not with the concept of cracking down on fraud, but with the potential process.
A number of years ago, the federal government determined it was overpaying doctors, hospitals and pharmacies for Medicare claims. The government began an aggressive campaign to sniff out such overpayments and outright fraud.
In this effort, working with local and federal prosecutors, the feds uncovered numerous instances of blatant fraud. This obviously cried out for aggressive prosecution.
Investigators also discovered many instances of simple errors in billing, resulting on occasion in overpayments to providers. These mistakes, too, should always be pinpointed and corrected.
Unfortunately, investigators often chose to confuse fraud with mistakes (even though required federal Medicare and Medicaid paperwork stands among the most convoluted in mankind's long love affair with bureaucracy).
Medicare billing regulations are enormously Byzantine - with opportunities for innocent mistakes to be made all the time. The same holds true for Medicaid.
The federal government also stamped the term "fraud" on many billing practices that had been standard among numerous providers nationwide for years. The federal government was quick to blackmail providers into reaching settlement agreements by threatening huge civil and criminal penalties. Smelling a whiff of Spanish Inquisition tactics, many providers settled even when they knew they were right, or that mistakes had been innocently made.
But the loose use of terms such as "fraud" when applied to billing mistakes tends to taint the entire provider community unnecessarily, perpetuating false stereotypes about the health care industry.
It also provides an easy escape hatch for the politicians. …


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