AMA opposition may doom effort to fight health fraud

Florida's new senator, George LeMieux, has introduced a bill (SB 2128) that would require health-care providers and suppliers to undergo background checks before being allowed to do business with Medicare and Medicaid.  He also favors using a system similar to that used by credit-card companies to detect fraud.
 
In other words, he thinks Medicare should stop sending out funds to dead doctors and wheelchair suppliers that exist only in a post-office box. What a concept!  

It's time Congress let Medicare take the same precautions that any sensible business owner would to keep from being fleeced. 

On Wednesday, the American Association for Homecare endorsed LeMieux's "Prevent Health Care Fraud Act of 2009," saying it contains several of the provisions called for in the association's own anti-fraud action plan proposed in February.

The association commended LeMieux for proposing "an aggressive, proactive approach to stopping fraud."

Maybe LeMieux should get together with Sen. Charles Grassley, R-Iowa. Grassley’s "Fighting Medicare Payment Fraud Act of 2009" (SB 2774) would give Medicare officials the flexibility to hold up payment if they had reason to suspect a claim was fraudulent.

Current federal law forces Medicare to pay in such a short time frame that there isn’t any feasible way to investigate before paying even obvious flim-flams.

“Because of this prompt payment rule,” Grassley said, “the government puts itself in a position of having to pay and chase Medicare fraud, instead of working to prevent it in the first place. That doesn’t make any sense and it’s no way to manage Medicare’s resources.”

But guess who opposes the Grassley bill? The American Medical Association. Health News Florida asked about it and got the response that AMA wouldn’t support the Grassley bill because it would give the HHS Secretary too much power to hold up payments. HHS wouldn’t need to go to court to show that it had a reasonable basis for the hold-up; that could lead to “a gross abuse of discretion and/or arbitrary and capricious decisions.”

The same physicians’ group that deplores the courts’ interference with medical practice is relying on the courts to keep those payments flowing quickly, even if it means a lot of crooks are getting payments, too.

It's time for members of Congress of both parties and the AMA to consider the welfare of the nation as a whole, especially the need to cut costs so that the uninsured can be covered. Fixing Medicare is everyone's job.

--Carol Gentry, Editor, can be reached at 727-410-3266 or at this e-mail.