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Started By
Message
Feds Begin Fingerprinting 'High Risk' Medicare Providers and Suppliers
Posted on 4/15/14 at 8:18 am
Posted on 4/15/14 at 8:18 am
LINK
Any doctors care to weigh in on this?
I don't understand how this makes sense. How do they define "bad actors"? You would think "bad actors" would have already been caught and prosecuted for "acting badly".
Any doctors care to weigh in on this?
quote:
Four years after Obamacare became law, the Department of Health and Human Services (HHS) is notifying Medicare providers and suppliers of new fingerprint-based background checks. Eventually, all individuals who hold a five percent or greater stake in a Medicare supplier or provider that is categorized as "high risk" will be subject to the requirement. The provision is part of the Medicare, Medicaid, and CHIP Program Integrity Provisions (Title E) of the Affordable Care Act, and gives the HHS secretary broad discretion in applying the background check requirements depending on the potential for abuse, fraud, and/or waste.
quote:
The new rules will apply to both current and future enrollees who are classified as "high risk," the stated purpose being to weed out "bad actors" in the Medicare program and prevent any more from enrolling.
I don't understand how this makes sense. How do they define "bad actors"? You would think "bad actors" would have already been caught and prosecuted for "acting badly".
3
Posted on 4/15/14 at 8:32 am to DosManos
Everybody is guilty of something.
Posted on 4/15/14 at 8:42 am to DosManos
quote:I don't understand the "fingerprinting" part of it (if they're talking about physicians) because the backgrounding for docs is already substantial.
I don't understand how this makes sense
OTOH the Feds are so incompetent running payment programs that they cannot differentiate between normal activity and distinctly abnormal activity. They will run a spot audit on a facility/provider generating few red flags, yet ignore the opthamologist down the street billing medicare $21million/yr. It's a real head scratcher. Government auditors will treat good folks like criminals, and bad folks with deference. There is no common sense filter. So perhaps this serves as an aid in addressing that?
Just like the IRS sending hundreds of thousands in "refund" checks via 250 returns to a single address. You would think a 7-digit total refund to a single address via multiple returns would generate questions. Not with our IRS. On the other hand, a school teacher erroneously claiming a deduction, well we just cannot have that! She'll need to be "taught a lesson." It is stupid beyond belief, but that is our illustrious federal government in action.
Bottomline: Anything that shifts focus to real billing fraud is a good thing. Don't know if this does or not though.
This post was edited on 4/15/14 at 8:43 am
Posted on 4/15/14 at 8:51 am to DosManos
I read about it earlier and the only thought that came to mind was simple. The govt. wants to have a documentable ID of all providers, yet try to get the same sort of thing for voters is a race based attempt to revert to the Jim Crow laws in the country and would be on the front page as such.
Posted on 4/15/14 at 8:52 am to NC_Tigah
quote:Just look at the TSA screening process and you realize common sense does not apply to government agencies.
I don't understand the "fingerprinting" part of it (if they're talking about physicians) because the backgrounding for docs is already substantial.
OTOH the Feds are so incompetent running payment programs that they cannot differentiate between normal activity and distinctly abnormal activity. They will run a spot audit on a facility/provider generating few red flags, yet ignore the opthamologist down the street billing medicare $21million/yr. It's a real head scratcher. Government auditors will treat good folks like criminals, and bad folks with deference. There is no common sense filter. So perhaps this serves as an aid in addressing that?
Just like the IRS sending hundreds of thousands in "refund" checks via 250 returns to a single address. You would think a 7-digit total refund to a single address via multiple returns would generate questions. Not with our IRS. On the other hand, a school teacher erroneously claiming a deduction, well we just cannot have that! She'll need to be "taught a lesson." It is stupid beyond belief, but that is our illustrious federal government in action.
Bottomline: Anything that shifts focus to real billing fraud is a good thing. Don't know if this does or not though.
Posted on 4/15/14 at 9:00 am to NC_Tigah
Well, this will just decrease the number of doctors willing to see Medicaid/Medicare patients even more.
It isn't that looking for fraud is a bad thing, but unintentional consequences should always be considered. I wouldn't undergo this program, but that's just me.
It isn't that looking for fraud is a bad thing, but unintentional consequences should always be considered. I wouldn't undergo this program, but that's just me.
This post was edited on 4/15/14 at 9:02 am
Posted on 4/15/14 at 9:02 am to dante
quote:Exactly! Great analogy.
Just look at the TSA screening process and you realize common sense does not apply to government agencies.
Search for medical fraud is the TSA approach. It is a carbon copy.
So perhaps the OP represents a slight improvement from that.
Posted on 4/15/14 at 9:03 am to dante
I don't understand, if you have DEA number, like I do, they have my prints....This can't be a Physician initiative, cause they already have that stuff..
Posted on 4/15/14 at 9:14 am to Scruffy
Practicing medicine is getting ridiculous, though. Almost every day there is a hurdle to overcome. They want to balance costs so much, that they will make you bleed to treat a patient. Now, my orders and H and P aren't enough, I have to sign a certificate of Admission stating a patient must be admitted, under penalty of law. Physicians that can get out, are jumping like rats, and its only going to get worse.
Posted on 4/15/14 at 9:18 am to Scruffy
There is a ton of fraud and abuse. Unfortunately, the way they are identifying their "outliers" also singles out busy, hardworking docs that see a lot of medicare/Medicaid. Generally those are us in underserved, rural areas. There is no separation. Just as when they release medicare payment info. The insinuation is that if a doc collects far more than average, he's a fraud or abusing the system. It's kind of bullshite. They need to crack down on fraud, but when I've notified them of fraudulent medical equipment suppliers, there's been no follow up. There's a secondary agenda here not related to fraud and abuse. Guaranteed.
Posted on 4/15/14 at 9:20 am to SmackoverHawg
quote:
There's a secondary agenda here not related to fraud and abuse.
And what would that be? I'm curious.
Posted on 4/15/14 at 9:20 am to NC_Tigah
quote:
Government auditors will treat good folks like criminals, and bad folks with deference
It's easier to collect fees from "good" people because they want to follow the rules. Good people do a better job of keeping paper trails so it's much easier to spot a mistake and fine them for it. It's like the common practice of placing red light cameras in good neighborhoods while ignoring the rougher parts where crime is actually higher. $$$ talks
Posted on 4/15/14 at 9:22 am to SmackoverHawg
quote:
There's a secondary agenda here not related to fraud and abuse. Guaranteed
They are trying to either run all the Docs off, or make it so tough to treat a patient, that they just will not do it; and turn America against them, for Nurse practitioners, or other modalities.
Posted on 4/15/14 at 9:23 am to DosManos
quote:
And what would that be? I'm curious.
Fines-simple fundraiser. It's easy to track down legit doc's. Fine a few issues and drop a $15k fine.
They want single payer, so drive out drive out those least likely to submit to being an employee
Political-The IRS did it. You think they won't single out politically outspoken docs? Ask Ben Carson if he got audited after his public remarks.
Posted on 4/15/14 at 9:23 am to CamdenTiger
quote:
They are trying to either run all the Docs off, or make it so tough to treat a patient, that they just will not do it; and turn America against them, for Nurse practitioners, or other modalities.
Pretty much this.
Posted on 4/15/14 at 9:25 am to CamdenTiger
quote:Hey. Hey.
are jumping like rats
That's a little bit harsh! I ain't neaux rat!
Posted on 4/15/14 at 9:32 am to CamdenTiger
quote:Soon healthcare will be just like the DMV. Stand in line for long periods of time only to have some indifferent government employee take your money. The best and brightest who are now our doctors will soon be searching for other ways to make money. Healthcare will eventually be provided by those who do not meet the qualifications of those practicing medicine today. A black market for medical care will emerge eventually.
They are trying to either run all the Docs off, or make it so tough to treat a patient, that they just will not do it; and turn America against them, for Nurse practitioners, or other modalities.
This post was edited on 4/15/14 at 9:35 am
Posted on 4/15/14 at 9:33 am to NC_Tigah
quote:
That's a little bit harsh! I ain't neaux rat!
LOL, yeah, just an expression. To be fair, the Docs I know aren't leaving because of Obamacare, at least not yet, but of electronic medical records, and loss of any control. Plus, most are just doing it because they love it(not income), and it gives them value in their lives, but now(with the current requirements), they are over that stuff.
Posted on 4/15/14 at 9:40 am to SmackoverHawg
quote:THIS !
but when I've notified them of fraudulent medical equipment suppliers, there's been no follow up
There was a news documentary about a dermatologist clearly gaming the system. Removed something like 75 lesions from one guy, no path reports, etc. Billed Medicare for thousands of BS procedures. Even after the expose' there was no follow up.
Posted on 4/15/14 at 9:45 am to CamdenTiger
quote:One family member and one close friend went self-pay only this year. Not an option for some fields though.
Physicians that can get out, are jumping like rats, and its only going to get worse.
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