Few texts can make the U.S. tax code read like a Sidney Sheldon
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
Now, our state government wants to hold health care
providers' feet to the fire for sometimes tripping up in this paper
"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
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
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
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
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.
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. …