$23 Billion Lost to Medicare Fraud: A Solution
This enormous leak in our large and growing Medicare program is a tough problem to solve. Many fraud detection programs have been in place for years and others are being rolled out now. Like the computer anti-virus sofware on your pc (and now Mac), fraud detection systems have to constantly expand and improve in order to keep up with the clever people who dedicate themselves to avoiding detection. All of these systems have the same premise, to reduce the fraud, waste and abuse in Medicare and Medicaid. One conspicuously absent element in the automation of fraud detection has been the Electronic Medical Record (EMR). For obvious privacy reasons, EMR data is not provided with every claim. However, when claims are flagged as potentially incorrect, medical record data is provided to the payer by the hospital or clinic. Usually that data comes as paper. Here is a new pilot program that will change the metaphor to EMR (to 3rd party auditors, not payers) with claims. This single step holds out great promise for reducing the fraud in our federal and hopefully soon, state, healthcare programs.