The Newsroom    Published Friday, Sep. 27, 2013, 3:53 PM
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Applying health care research to problem of health care fraud

General Surgery News, September 1, 2013

The False Claims Act, a Lincoln-era statute, allows not only the government but also individuals acting on the government’s behalf to sue for restitution of payments for knowingly fraudulent claims to the government. These can include bills for worthless services, a category that may include procedures with no medical value. UTMB’s Dr. James Goodwin said prosecuting doctors for performing unnecessary procedures is not the answer. “I assume the physicians who are performing screening colonoscopy too frequently have managed to convince themselves that they are doing the right thing. If Medicare refused reimbursement for those procedures, the problem would disappear overnight,” he said. Overall, however, Goodwin said forensic health services research is “a good idea. The distinction between ‘fraud’ and ‘abuse’ can be debated endlessly, but there is no doubt that using administrative data to identify clinics and providers with ‘abuse-like’ profiles for further scrutiny could have a major impact on overuse of tests, procedures and treatments.”
 




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