Thursday, March 10, 2016

GAO Finds Smart Cards Won't Stop Most Healthcare Fraud

Regardless of one’s political affiliation, the elimination of fraud from government healthcare programs is an issue universally supported. In 2014, the Department of Justice spent $571 million to find and prosecute fraud and recover $3.3 billion in settlements.

A proposed solution to cutting fraud is incorporating technology. Recently, the Government Accountability Office conducted study examining whether electronically readable card technology, or “smart cards,” could weed out fraud by properly identifying beneficiaries or providers at the point of care.

In the report, the GAO found that smart cards could spot some types of fraud, but not most. This is because the vast majority of cases involve schemes in which the beneficiaries or the providers—or both—were complicit in the action.

GAO ran tests of 739 fraud cases from 2010 to determine whether the use smart cards would have made a difference. The results were not promising: in only 165 cases (22%) would smart cards have been able to prevent fraud.

The investigators gave several reasons why smart cards are not a cure-all for Medicare and Medicaid fraud. The most common fraud schemes involve billing for services that were not provided (43%) or for medically unnecessary services (25%), and in the case of Medicare especially, the patient may not even be aware that the service is not needed. Other schemes involve falsifying records to support fraud (25%) and fraudulently obtaining controlled substances or mis-branding prescription drugs (21%).

In sum, GAO finds that when it comes to fraud, providers are complicit 62% of the time, while beneficiaries are at fault 14% of the time.  

The original article by Mary Caffrey can be found at the following address:

No comments:

Post a Comment