New Ideas To Eliminate Fraud
It’s been estimated that fraud adds as much as $60 billion a year to our healthcare costs. Well, the problem has gotten the attention of the Office of the Inspector General (OIG) which is tasked with protecting the integrity of the Medicare and Medicaid programs and the health and welfare of program beneficiaries.
In this week’s issue of the New England Journal of Medicine, Dr. Julie Taitsman, the Chief Medical Officer of the OIG, discusses efforts to educate physicians about laws designed to prevent fraud, waste, and abuse.
“Most physicians are honest, earning respect and trust from both payers and patients. But these cases (of fraud) are not isolated. Numerous other U.S. physicians have served prison terms, paid hefty fines, or faced other civil, criminal, and administrative penalties for accepting kickbacks, upcoding bills, or making improper self-referrals. More than 5000 physicians are currently excluded from participation in the federal health care programs because of these types of violations and cannot treat any of the approximately 100 million Medicare and Medicaid beneficiaries,” says Taitsman.
I don’t believe docs enter the medical profession with the intent of committing fraud. Where ignorance of the law plays a role in fraud, the OIG may have a solution, says Taitsman. Educating physicians about the law must take place while they’re in medical school. Unfortunately, medical schools are not doing a very good job at this.
In April 2010, the OIG surveyed all medical school deans and designated officials for institutions that sponsor residency and fellowship programs to determine whether their institutions provide education about fraud, waste, and abuse. About two thirds of the designated institutional officials (only 59 percent could be bothered answering the survey) and 44 percent of deans (response rate, 82 percent) reported that their institutions provided at least some training on fraud and abuse for students, residents, or fellows.
I am not surprised at the low response given that many medical schools have themselves been found guilty of Medicare fraud.
The OIG wants to ensure that all future physicians learn about fraud, waste, and abuse. First, medical educators must recognize the importance of teaching about the integrity of the Medicare and Medicaid programs, and second, the OIG needs to help medical schools develop the tools to effectively and comprehensively teach this topic.
Hopefully, the OIG realizes that the problem of fraud starts at the top. Remember, 41 percent of those surveyed couldn’t be bothered answering the survey and medical schools themselves have been fined for committing fraud. Some role models, huh?
The OIG must begin by training the Presidents, Deans and other leaders of these educational institutions before training the students. Medical schools must lead by example!
Jeffrey Kreisberg blogs regularly at Taking Control of Your Healthcare.
