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April 15, 2014

THEIR VIEW: Health care fraud can't go unchecked

National health care spending tops $2.7 trillion annually.

That leaves a lot of room, and temptation, for abuse of a bureaucracy that administers medical services.

Medicare and Medicaid scams may cost taxpayers more than $98 billion each year.

Health care fraud affects us all, from the cost of investigations to the impact on taxpayers. There have been reports that patients can’t get the care they need because fraudulent charges used up their allotted Medicare benefits — which in turn jeopardizes a patient’s health.

Locally, there have been recent investigations involving Medicaid billings at the Madison County Community Health Center and the Anderson Dental Center.

Years ago, both hospitals in the city paid hefty fines to resolve allegations that they overcharged the Medicare program for a medical procedure known as kyphoplasty used in osteoporosis.

Some cases are human error certainly. Others are not so innocent as people see federal funds as a source of get-rich-quick opportunities.

In February, the Department of Justice and Health and Human Services reported that for every dollar spent by the Health Care Fraud and Abuse Control program investigating health care-related fraud and abuse, the government recovered $8.10. It was the highest three-year return on investment in the 17 years that the fraud program has been in operation.

The program recovered $4.3 billion in 2013; that’s taxpayer money intended for use for senior services and people in dire need of medical assistance.

Fraud can be reported to the Health and Human Services Office of Inspector General or Centers for Medicare and Medicaid Services. Go to www.stopmedicaidfraud.gov to find resources.

Indiana has an active fraud control unit that works with Health and Human Services, the Inspector General, the FBI and Internal Revenue Service. U.S. Attorney Joe Hogsett’s office also works with those units.

Those investigations are costly. But more costly are the human costs in not being able to provide adequate health services.

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