Medicare Fraud Rampant, Keynoter Says

Up to 20 percent of Medicare expenditures are going to fraudulent claims, the keynote presenter on the final day of HIMSS 2010 said.

Independent fraud investigator Harry Markopolos said the government is doing a poor job of monitoring the money it spends on healthcare. Interviewed by CNN medical correspondent Sanjay Gupta, M.D., Markopolos noted that the fraudulent practices run the gamut from billing on behalf of dead patients or dead physicians to upcoding claims, and asking for more than is deserved. "Medicare fraud is pervasive," Markopolos said. "Wall Street is second fiddle to the health care industry."

Upcoding is the most common method of fraud, Markopolos noted. Part of the problem stems from the very complexity of billing rules, he added. "Physicians are not trained to bill."

Celebrated for his work exposing the ponzi scheme of Bernard Madoff, Markopolos said that health information technology is a double-edged sword when it comes to fraud. "The EHR can make fraud easier to find, but also makes it easier to camouflage." He urged the industry to get its own act together, or face the prospects of an intense legal crackdown, which would likely include the use of undercover patients seeking to ferret out unscrupulous providers.

--Gary Baldwin