WASHINGTON – New Medicare models for paying hospitals and doctors will require a shift in the focus of fraud investigators, a top federal official warned today in prepared testimony.
The current "fee-for-service’’ reimbursement system is open to familiar scams where doctors and other caregivers order excessive procedures, bilking the government unnecessary charges. But under a variety of cost-saving plans under development that will use "bundled’’ and "global’’ payments – flat fees to treat certain types of patients – the danger is that some corrupt providers cheat patients and the government by skimping on care.
"When the program pays on a capitated basis, the incentives are reversed; unethical providers stint on needed care,’’ said Lewis Morris, chief counsel for the Office of Inspector General in the Department of Health and Human Services.
"Experience has taught us that how health care programs pay for services dictates how the programs are defrauded,’’ he said.
Morris's remarks were contained in prepared testimony for an appearance today before oversight panels of the House Ways and Means Committee.
The Office of Inspector General is developing plans to scrutinize new models of care to block fraud opportunities, Morris said. The new health care overhaul law signed by President Obama this year, he added, gives OIG investigators better tools to scrutinize Medicare computer data in a hunt for fraud.
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Glen Johnson is Politics Editor at boston.com and lead blogger for "Political Intelligence." He moved to Massachusetts in the fourth grade, and has covered local, state, and national politics for over 25 years. E-mail him at email@example.com. Follow him on Twitter @globeglen.