Medicaid Fraud Dragnet ls Missing the Point, States the Association of American Physicians and Surgeons (AAPS)
Fraud in Medicaid is indeed "stunning," according to a report released by the
Then there are huge kickbacks ("rebates") that would be illegal in other industries but are permitted in "safe harbors" for Group Purchasing Organizations (GPOs) and Pharmacy Benefits Managers (PBMs). The resulting buyers' monopoly may drain
There is nothing new in the attack on physicians who serve Medicare, Medicaid, and Tricare patients, Dr. Orient noted. It began in 1996 with provisions in the Health Insurance Portability and Accountability Act (HIPAA), which criminalized billing errors or providing "medically unnecessary services"—one of the crimes that
The last "largest-ever federal health care fraud takedown" occurred in 2011. Then, as now, some of the accused were probably guilty of running egregious scams. "There is no excuse for intentionally defrauding the taxpayer," stated Dr. Orient, "but many physicians have had their lives ruined because of inadvertent violations of complex billing rules while they were working very hard, caring for patients."
"Physicians feel that they are not only being blamed, but hunted," Dr. Orient said.
The criminalization of medical practice is not the answer, in the view of AAPS. In contrast,
"All physicians who accept payment from a government health program are at risk," Dr. Orient stated. "But putting them in prison for decades won't rescue Medicaid. The really huge swindle of the American taxpayer will go on."
The
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