side note: This blog maintains its focus on medical professional liability insurance and medical malpractice, but this article was such an eye opener this morning, we had to share.
The Hill: “Independent federal investigators hoping to rein in Medicare fraud are asking Congress for broad new authority to boot offending corporate executives from the insurance program. The change is designed to control Medicare claims fraud by punishing culpable owners, managers and other corporate higher-ups, and not just the convicted companies. … Under current law, HHS can exclude from all federal healthcare programs any owner or employee who knew, or should have known, about a healthcare scheme leading to a company’s conviction. But to be subject to the exclusion, the offending person must still be with the company.” As a result, “[c]ulpable executives can resign – and offending owners can divest – immediately after a company’s conviction”, leaving Office of the Inspector General officials without power to prevent them from “participating in federal health programs with other companies. OIG wants Congress to expand its exclusion authority to include any worker – past or present – found responsible for the fraud” (Lillis, 6/15).
The Boston Globe: A federal official told Congress Wednesday that some of the new Medicare models for reimbursing doctors and hospitals, such as those using “bundled” payments or flat fees for specific conditions increase “the danger” that providers could “cheat patients and the government by skimping on care. … The Office of Inspector General is developing plans to scrutinize new models of care to block fraud opportunities, said [Lewis Morris, chief counsel for the Office of Inspector General in the Department of Health and Human Services]. The new health care overhaul law signed by President Obama this year, he added, gives OIG investigators better tools to scrutinize Medicare computer data in a hunt for fraud” (Rowland, 6/15).
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