Fraud and Abuse–Are We Doing Enough to Stop It?

A column in the current New England Journal of Medicine raises again the prospect that deterring fraud and abuse might provide substantial health care savings.   The article cites $60 billion as a conservative amount being wasted through fraud and abuse.  The Bush administration had asked for additional resources to combat fraud, but Congress would not provide this funding.  The current administration is similarly seeking more money to support antifraud programs.  Medicare and Medicaid have either been particular targets of the defrauders or they have done a worse job than the private sector at rooting out fraud.  For those who support a public insurance plan, it is worth noting that Medicare and Medicaid have a very poor history of innovation not only in this area, but in encouraging wellness and more appropriate care delivery by providers.  In any event, the payback from enhanced antifraud programs is so great that it is hard to imagine why all needed resources aren’t devoted to the effort.