Monday, May 20, 2013
Stop Medicare Fraud
I applaud the efforts of the Miami Herald Editorial Board to refocus our collective attention on the out-of-control Medicare fraud in South Florida.
Several former and current leaders of organized medicine in Florida have attempted to address and resolve this problem only to find themselves rebuffed by a wall of silence, feigned commitment to seek solutions, or refusal to accept responsibility.
During my tenure as President of the Dade County Medical Association I traveled to Jacksonville to meet with the leadership of First Coast Service Option, advertised as " one of the nation’s largest Medicare administrators for more than 45 years, and is the current Medicare Administrative Contractor (MAC) for Jurisdiction 9 (J9), which includes Puerto Rico, the U.S. Virgin Islands and Florida." Once I "dared" to raise the issue of accountability and transparency for the (in)action in regards to Medicare fraud and contacted Senator Nelson, I was reminded that my public position could be interpreted as defaming their business and might trigger legal action. Needless to say that I had to back off.
Why does nobody hold Medicare contractors such as FCSO accountable for their inability to stop blatant Medicare fraud? Why do honest providers toil under intense scrutiny, whereas others gain outsize profit with brazen abuse?
Until we are addressing those issues nothing will change.
Yours
Bernd
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Great Question: Medicare and Medicaid Health care fraud in the US is now and has been rampant since the program was initiated. The program was started in the Johnson Administration in 1966 and it took them 30 years to even have a national provider enrollment application. That is, the current 855B, I, R, and S Forms were not used prior to 1996. Which is one of the reasons why the health care waste, fraud and abuse exploded. There were not even rudimentary checks of provider offices by the Medicare contractors. In fact, there were not even Medicare numbers prior to 1996. The parent companies issued a numeric numbers to providers and what ever number the parent company issued became their Medicare number. There was no national number. The oversight was flat by HCFA at the time, was flat out negligent. Read Dr. Malcolm Sparrows' book License to Steal. What is even more troubling, is that Medicare and Medicaid have been the tail wagging the dog. This not only goes for health care fraud but pricing of goods and services as well. Health care waste, fraud and abuse in government programs translates to higher prices for everything from office visits to durable medical equipment to maintenance for the machines, and insurance required by health care providers, diagnostic tests and prescribed drugs. In short, it is a prescription for higher health care costs for all Americans.
Al
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