Obama Administration Enlists Consumers In Its Crusade Against Medical Fraud

Medical errors, fraud, and systemic abuse in U.S. health care are unnecessary and largely-preventable contributors to the nation’s rising health costs. Americans tend to trust their doctors and caretakers, but evidence suggests that in some instances, their faith is misplaced. The Obama Administration, through anti-fraud provisions in the health reform law and independent Administration efforts, is cracking down on insurance companies, doctors, and providers who game the system for personal benefit.

In their most explicit warnings to health care providers to date, Attorney General Eric Holder and Secretary of Health and Human Services (HHS) Kathleen Sebelius issued a letter to hospital trade associations on Monday cautioning that fraud in Medicare billing paperwork and illegal practices such as “upcoding” would be met with the full force of federal law. As the letter declares, “False documentation of care is not just bad patient care; it’s illegal.”

And The New York Times reports that the Administration wants to go one step further by instituting a new federal initiative that would allow consumers and patients to fill out a questionnaire assessing their care and hospital stays. Initial versions of the “care questionnaire” include questions meant to discern possible medical errors by doctor, hospitals, and pharmacists:

A draft questionnaire asks patients to “tell us the name and address of the doctor, nurse or other health care provider involved in the mistake.” And it asks patients for permission to share the reports with health care providers “so they can learn about what went wrong and improve safety.”

In seeking White House approval this month for a prototype of the reporting system, Dr. Carolyn M. Clancy, the director of the federal Agency for Healthcare Research and Quality, a part of the Public Health Service, said, “Currently there is no mechanism for consumers to report information about patient safety events.”

“Patient reports could complement and enhance reports from providers and thus produce a more complete and accurate understanding of the prevalence and characteristics” of medical errors, Dr. Clancy said.

The Obama Administration has already reinforced existing Medicare anti-fraud programs in recent days by allocating an additional $7 million to the national Senior Medicare Patrol program, a volunteer-driven consumer-protection group that trains seniors, Medicare beneficiaries, and care providers how to identify and report Medicare fraud.

By some estimates, consumer-empowerment measures and medical anti-fraud programs could save close to $4 billion in wasteful medical spending annually.