U.S. Attorney To Attack Fraud In Health Care
By Rich Lord and Torsten Ove, Pittsburgh Post-Gazette | |
McClatchy-Tribune Information Services |
In
"Health care funding is supposed to be spent on making people better. It's not supposed to go to fraudsters,"
"This is not about taking the resources of the federal government and going after small ball fraud," he added. "This is a huge commitment of resources to something that I feel very strongly about."
The initiative makes his office an instant factor in a contentious industry -- one in which just this year a Highmark affiliate reported a kickback issue in its own system, and that insurer sued UPMC, accusing it of systematic overbilling.
"We always are cautious about allowing two combatants in a civil dispute to try to draw us into that,"
Both UPMC and Highmark welcomed his plans.
"If we're trying to control costs at all levels, it makes sense to do that," said
In an environment of limited resources, "health care fraud hurts us all and we all have an interest in and a responsibility to weed out fraud, so we welcome additional resources that target fraud on government programs, our health plans and our patients," wrote UPMC spokeswoman
"UPMC commits substantial resources to monitoring our billing and other financial interactions with payers and patients to avoid mistakes, and correct them if they are discovered after the fact," she continued. "We hope the new federal resources will be deployed judiciously in [a] manner that carefully distinguishes between mistakes and the fraudulent practices they were designed to combat."
X-ray vision
Health care fraud investigation and prosecution isn't a complete novelty in
Former X-ray technician
Joining
Targets will include those who bill
This month Highmark sued UPMC, alleging upcoding in its chemotherapy billing. UPMC called that lawsuit "a meritless attack on a reimbursement system Highmark itself designed and endorsed."
In March,
"It is really not about sitting and waiting" for cases, he said. His office, he said, is combing health care data for <location idsrc="xmltag.org" value="LS/us.pa">Western Pennsylvania, looking for anomalies that might suggest fraud.
"We're going to be, in a very short while, delivering a series of very good health care fraud cases," he said.
"He's insinuating, of course, that they're not just going for mom and pops," said
The area's health care giants, though, would be hard targets. "Bigger organizations have more resources to evaluate their practices, try to prevent these kinds of accidental infractions, and to catch them and self-report,"
The
"We still don't have a resident, dedicated [
The Health and
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Last year, pharmaceutical giant
This month his office filed court motions to seize
Highmark uses data analytics to study all of the claims submitted, including those from its
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