1) I doubt there is any increase in fraud. I haven't seen any statements that claim that there actually is, just this "warning." What is being stated is that payments (costs to taxpayers) have gone up. This is after the administration passed the ARRA and the ACA, telling us we would be grateful when we saw the costs start to drop. So now that the costs are rising, this allegation of fraud comes out. How about this... maybe EHR systems improve a hospital's ability to track and get paid for legitimate charges that might have been missed in their old systems? They are playing the blame game to try and explain why their predictions are not coming true.”
2) “Health care coding is impossibly complex, and this complexity prevents physicians from knowing what the rules for billing and coding are. Medicare manuals on the topic literally run into the tens of thousands of pages, and entire professions are dedicated to this one very complex (and expensive to implement) part of health care. Most physicians have only the most rudimentary knowledge of the 30 or 40 codes they use most often.
“As has been Medicare's fashion in recent years, the penalties levied against physicians far outweigh the equivalent penalties in other business areas. It is absolutely correct to state that physicians have, for a number of years, been consistently under-coding for their services. The increasing risk of fraud allegations, the severity of the fines and the relative ignorance of the bureaucratic web of coding regulations have conspired to ensure this under-coding has occurred, and it is a commonly accepted belief in medicine that this confluence of factors has not been coincidental. The ‘miracle’ of EMRs has allowed the under-coding to stop. Complicated algorithms are able to match the complicated rules, and physicians are able to confidently bill for the actual services they provide.
“Obamacare is, as has been predicted, going to be proven an economic disaster, and it appears that will happen even sooner than the original fairly pessimistic forecasts. CMS is afraid that they will (rightfully) be made the scapegoat as costs continue to skyrocket, and the current anti-fraud stance is as much (if not more) about positioning for failure as it is about any real concern over rising costs. The government has designed the system of conflicting rules and confounding complexity which we call health care, but Secretary Sebelius and her co-conspirators don't seem willing to either accept responsibility for the consequences nor to have any willingness to reverse course and stop the regulatory steamroller. It is deliciously ironic that they now find themselves in this position, and that we have EMRs to thank for it.”
3) “CMS as usual makes the rules so complex that it takes a computer to follow the rules and if they are followed, than fine everybody and see what sticks. Why not base payment on pathways, ICD-9 diagnoses and CPT 4 procedures performed? Or, maybe just add more garbage to meaningful use and waste more time and money. Health care strike anyone? Let's take back health care and spend money for care and not paper-pushing.”
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