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Editorial: Fighting Medicare fraud

Editorial: Fighting Medicare fraud

Medical fraud costs the federal government plenty — by one estimate, at least $70 billion a year — and Connecticut, as a high-cost-of-living state, surely plays its part.

But we’re not, generally speaking, talking here about Grandpa trying to get a second walker, or Aunt Josephine asking for pills she doesn’t need.

No, most of this abuse of the system is attributed to fraudulent bills from doctors, hospitals, pharmaceutical companies and medical equipment salesmen.

Uncle Sam is waging war against such fraud, both here and across the country, and has prosecuted doctors and drug companies.

A Stratford-based general practitioner, for example, agreed to pay $700,000 in a case involving fraudulent billing at several nursing homes.

And a Guilford podiatrist pleaded guilty to billing Medicare $200,000 for treatments that were not performed.

In order to fight fraud, the Centers for Medicare & Medicaid Services has released data on hundreds of thousands of doctors and medical facilities that billed Medicare in 2012.

This information was released — over the objections of the American Medical Association — and can be found at a CT Mirror website (http://ctmirror.org/medicare-payout-by-provider/), where you can look up individual doctors to see how much they billed Medicare and how much they were paid.

While it’s good that this information is now available, it does come with some caveats:

It should be noted that high figures billed by a high-volume practice do not in themselves suggest fraud; and that some specialties, such as ophthalmology, tend to run up high bills because of unique drug or equipment costs.

It may also be educational to compare the reimbursement rates for different doctors — amount billed vs. amount paid — while noting that there can be marked differences between the rates for primary-care doctors and specialists.

While many of these charges may be quite reasonable, there seem to be plenty of fraudsters out there too, and the government is trying to fight them with a limited number of attorneys and prosecutors.

Uncle Sam may be woefully outnumbered.

And while the Mirror reports that thousands of doctors have been “exempted” from Medicare because of fraud, you have to wonder why more of them aren’t behind bars.

“If all you do is bark, and you never bite,” said Patrick Burns, co-director of Taxpayers Against Fraud, “people will lose respect.”

Unfortunately, it seems that they already have.


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