Health care fraud costs American taxpayers tremendous sums of money each year. Some experts say health care fraud is about 3% of all health care expenditures. If it is only 3%, it would amount to $60 billion, based on total expenditures of $2 trillion. But Malcolm Sparrow, a professor of public management at Harvard’s John F. Kennedy School of Government, believes the number is probably much higher. He says the number could be as high as 20%, which if true, would make the number be more like $400 billion. Professor Sparrow says the government knows how to measure health care fraud, but refuses to do so. Why? He says “the news would be too bad.”
Lewis Morris, the chief counsel at the Office of Inspector General at the Department of Health and Human Services, is at the center of the fight against health care fraud. He told Corporate Crime Reporter the federal government “does not have a valid way of measuring the true, precise level of health care fraud.” Mr. Morris, who says the real problem is proving the fraud, had this to say:
It is a big jump to move from a billing error to a fraud. Fraud is an intent based act. In order to establish it, you need someone to admit it, or you need sufficient evidence to prove it. And you would need to build that circumstantial evidence in each one of the cases that you counted toward your fraud statistic. It may be doable, but with the resources we have now, I would rather go after the bad guys that are in our scopes right now rather than trying to perfect the percentage point of fraud. If the thought is we know how to measure it and we have affirmatively decided not to, and therefore have asked civil servants like myself to be part of a cover-up so we keep the bad news from the public – that smacks of conspiracy to me. Certainly, those of us in the fraud fighting business would love to have more resources to do our job better. So, we have every incentive to bring the scope of this problem and the nature of this problem to the attention of policy makers. And we are doing that.
Based on our experience in the on-going Medicaid fraud litigation, I am convinced there is a massive amount of healthcare fraud in this country. This fraud is being paid for by the American taxpayers. I wonder why groups like the U.S. Chamber of Commerce aren’t concerned about this very large problem.
Source: Corporate Crime Reporter
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