New Emphasis on Curbing Medicaid Fraud

September 25, 2010 (Press-News.org) New Emphasis on Curbing Medicaid Fraud

In 2009, President Obama revealed that Medicare and Medicaid are the biggest drivers of the federal deficit and debt. Both programs are crucial to the health care industry in the United States; however, crippling waste, abuse and fraud cost the system $60 billion annually. As such, the Obama administration seeks to crack down on Medicaid and Medicare fraud.

Reports of flagrant Medicaid and Medicare fraud prompt public outcries. Consider the case of Elizabeth Corbitt, who in August was arrested on 419 counts of Medicaid fraud and one count of theft. Her case is not an isolated incident. In Chicago, Dr. Sushil Seth was convicted of fraudulently billing patient care for almost five years.

Health care fraud covers anything from questionable billing to transportation, home health and medical device scams. In the past, Medicaid and Medicare enforcement actions may have been nominal, but this trend is already changing on federal and state levels. With the White House administration's call for effective enforcement, medical professionals who receive federal funding may be under stricter scrutiny and subject to allegations of waste, fraud or abuse.

The consequences of Medicaid and Medicare fraud charges can have professional and financial repercussions as well as prompt governmental action from administrative, civil and criminal tribunals. Even well-intentioned medical providers may be subject to scrutiny and must take steps to insulate themselves and their practices from criminal and civil liability.

It is important to make sure billing procedures comply with federal and state standards and have audits of your own system to find billing and documentation errors. Be proactive in properly training personnel who handle service delivery and bill processes. Having accurate records helps in making a strong defense against fraud claims.

Even if a fraud claim is made against medical professionals, they should consider immediately retaining counsel who has experience with the complicated Medicaid and Medicare matters. Often, unintentional errors can be resolved through negotiation and settlements. If litigation or investigations become more complex, assistance of counsel may save more than a practice.

Since 1965, when Medicare and Medicaid were signed into law, these health care programs have grown into a complicated system of allowances, restrictions and penalties that are ripe for waste and fraud. However, conscientious medical providers need not be victims of health care reform as our nation moves toward more stringent enforcement of health care abuses.

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