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.