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: http://www.ajmc.com/focus-of-the-week/0216/smart-cards-wouldnt-stop-most-healthcare-fraud-gao-finds?utm_source=Informz&utm_medium=AJMC&utm_campaign=MC%5FMinute%5F2%2D24%2D16
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