Thursday, March 4, 2010

Dr. Sanjay Gupta here at #HIMSS10 discussing Medicare fraud @SanjayGuptaCNN

For some of you, HIMSS10 may be over. The exhibit hall closed yesterday, but the educational sessions are still continuing. This morning, I had the chance to see Dr. Sanjay Gupta from CNN interview Harry Markopolos, CPA. The discussion revolved around Medicare fraud which is a huge problem in this country.

Here were some key points from this keynote:
  • Medicare fraud story: $100 million were being billed by criminals who were using the names of deceased physicians.
  • Roughly $80 billion - fraud? Maybe $40 billion? Probably $60 billion each year. 
  • Discussion revolved the Bernie Madoff Ponzi scheme.
  • Do we need "undercover" patients to investigate whether doctors are breaking Medicare rules? (your next patient could be wearing a wire)
  • Only $20 million is spent on fraud investigation. Is this enough?
  • If women are being billed for male diseases, this could signal fraud (women won't be diagnosed or treated with prostate cancer)
  • Examples of Medicare fraud: upcoding, billing for procedures that were never done, off-label marketing, kickbacks, etc.
  • Where is the Medicare fraud occurring? Some doctors may feel a sense of entitlement and they may rationalize their behavior. 
  • The EHR may be a double-edged sword. Medicare fraud may be easier to detect, but you may lose some evidence. 
  • Don't title your accounts "slush funds" or "kickback accounts" because that may indicate that fraud may be occurring.
  • Some doctors are billing for 80 hours of day. (not a typo - 80 hours each day)
  • Whistle blowers receive a financial incentive based on the final settlement.
  • Corporate integrity agreements result in additional IT work and reports.
  • Will Medicare go bankrupt by 2017 or 2019?
  • Some hospice providers may be caring for dead patients.  
  • The worst nightmare for an IT professional is a Medicare fraud investigation. 
  • How do we protect Medicare beneficiaries?  Check their charts and their medical bills.
  • Some physicians are being trained by "senior staff" to upcode. Do you know how to bill accurately?
Special thanks to HP for sponsoring me to blog about HIMSS10.

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