Fraudulent Medicare billing would have cost the U.S. 4 billion dollars between Oct 1st, 2009 and Sep 30th, 2010, if the department of health and human services had not worked with the Justice Department to bring the HEAT (Health Care Fraud Prevention & Enforcement Action Team) on fraud. http://money.cnn.com/2011/01/24/news/economy/health_care_fraud/
When I typically think of committees aiming to reduce the cost of health in the U.S., I imagine a team of professionals sitting in large office chairs around an oval table deciding which scans, procedures, and patterns are most expensive, questioning whether or not they are necessary, and then attempting to create algorithms around them. Until I read this article, I did not realize that cutting healthcare expenditures could entail processing and screening a mass of insurance claims to find patterns that would indicate someone, who may not even be a health practitioner, is using patient information to steal money from the government.
Health fraud is not limited to the U.S. This article on NPR: http://www.npr.org/blogs/health/2011/01/24/133188263/global-health-fund-finds-some-fraud-recoups-losses explains that workers pocketed some 34 million dollars belonging to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. It is infuriating that anyone would steal money intended to improve health conditions globally.
This article mentioned that health funds are particularly vulnerable to fraud. It is easy for money to slip through the cracks when it is transfered from group to group. The Fund's executive director said they devote a lot of energy to discovering any misuse of funds. Might it be useful to devise methods for preventing money leaks before they happen rather than uncovering them after the fact? Would this even be feasible?
These articles broadened my perspective on the economic aspects of health. I wonder, what are other non-traditional ways of reducing health spending?
I was amazed at how much money the Health Care Fraud Team recovered this year. What shocks me the most is how much more money was probably stolen last year that the team recovered. I don't even want to take a guess as to how high that number might be.
ReplyDeleteI found an article in the Los Angeles Times that explained a little bit more about how exactly these Teams go about finding these frauds. http://www.latimes.com/news/nationworld/nation/la-na-whistle-blower-20110124,0,5954723.story?page=1
I wonder why something like this was not done a long time ago, but I am certainly very happy that it has started. I hope that efforts like this will continue to cut down on attacks on the poorest of the poor in our country and around the globe.
This was so interesting to me, because this article blends a lot of what we are talking about in another class that I am taking, Contemporary Challenges in Health Care. We are studying the ins and outs of the American system and how we can see where we are strong and where we are weak, and then make informed decisions about the health care the we receive as well as the health care that we advocate to be a part of our future.
ReplyDeleteIn our textbook (Niles, Nancy J. Basics of the U.S. Health Care System. Sudbury, MA: Jones and Bartlett, 2011. Print.), many good facets of our American Health Care System that I am taking into consideration when thinking on the dealings of the Health Care Fraud Team. When looking at an issue like this, it is important to identify where the money could be going. Stakeholders in our health care industry range so far and wide on account of the fact that we have both private and public sectors, with branches all over the place. The reason our health care system ended up this way in the first place was because coming out of the Depression and World War II, the US did not have enough funds to start a universal healthcare program. However, now we are left with stakeholders in the industry ranging from consumers, to employers, to hospitals, to care facilities, to physicians, to outpatient care centers, to laboratories, to the government, and to insurance companies. With so many people involved in the money and workings of the health care system, it is no wonder that the Health Care Fraud Team has such a large job ahead of them! It is so interesting, I agree, that I never even tend to take into account that things like this happen.