The CMS Can’t Get Rid of Fraud


Found this information on the Family Medicine SmartBrief:

Lawmakers criticized the CMS for not doing enough to eliminate fraud, waste and abuse in the Medicare and Medicaid programs. Reports from the Office of Inspector General show that fingerprint-based criminal background checks were not used in 37 states and site visits were not done in 11 states prior to Medicaid enrollment. The OIG also found that 12% of health care professionals terminated for cause in 2011 were still active in Medicaid programs of other states in 2012 because there is no comprehensive CMS database to identify terminated clinicians.

The article is located here. I found some more delicious tidbits:

Investigations by the Government Accountability Office found flaws in the software the CMS uses to verify providers addresses, leading to more than 26,000 providers with addresses not matching any on file with the U.S. Postal Service.

Once again the government is the perfect one NOT to put in charge of our healthcare system.  Can you imagine an insurance company slipping up like this?  Even though I hate them it doesn’t mean I don’t respect them for running a tight ship.  Remember this post of the doctor wouldn’t do the MOC?  Yeah, the insurance companies got her right away.  And she did nothing wrong!

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “The CMS Can’t Get Rid of Fraud

  1. Alan Schorr
    June 1, 2016 at 11:51 am

    Interesting. I have a cousin who was essentially put out of business in the UK as a physician under similar circumstances. Her payments were withheld as the NHS could not verify her office address. She had been in practice in the same office for 25 years. She left practice rather than go throught the nonsense. We are going down the same path, as we do not learn from history.

  2. Sir Lance-a-lot
    May 30, 2016 at 6:42 am

    “… more than 26,000 providers with addresses not matching any on file with the U.S. Postal Service.”

    This is meaningless, and could simply indicate addresses that are missing Zip codes.

    It also likely includes offices that are within small villages, where the PO does not deliver mail door-to-door, and where residents must go to the PO to pick up their mail (such as where I live); in these places, your actual street address is not a “valid postal address” because it is not in their database, but it is nonetheless very real. (Note that some on-line shippers, such as Groupon, are refusing to ship to non-valid PO addresses now, even though they use UPS or FedEx, creating a situation where people in certain areas simply cannot order from them: UPS and FedEx cannot deliver to PO boxes, and the ordering computer will not put through an order to the actual street addresses where UPS and FedEx DO deliver, and they do not offer the option of shipping via USPS).

    Sorry. Pet peeve.

    I would also be suspicious of any “cause” cited by a hospital for firing a doctor, as they will fire any doctor they perceive to be a troublemaker, such as someone who confronts the administrators on their bullshit.

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