The Kaiser Network recently highlighted a story from the Wall Street Journal about fraud in private sector Medicare and Medicaid managed care plans. (Kaiser Network)
In the 1990s, the federal government moved more Medicare and Medicaid beneficiaries to managed care plans in the private sector to reduce costs. Although some believed the private sector would have incentives to conduct business ethically and prevent fraud, others believe a new kind of fraud has cropped up. An excerpt:
The Journal reports that traditional fraud prevention for government programs consisted of “policing doctors, hospitals, dialysis centers and the like to catch overcharges or billing for treatment never provided.” However, according to the Journal, “[m]anaged care fraudsters profit by … shortchanging patients or physicians to cut costs while collecting preset fees from the government,” as well as by “refus[ing] to enroll unhealthy people, skimp[ing] on paying doctors or deny[ing] patients care.” Regulators say “they are realizing they must become more attuned to more-complex scams carried out by sophisticated corporations,” the Journal reports.
