Anti-Fraud Program is a Double-edged Sword

The federal government recovered $4 billion in “fraudulent” payments through Medicare and Medicaid last year. It is impressive that criminal activity is being found, and that inappropriate payments are being recovered. However, rules for coding and reimbursement for these programs are not always clear. Some patients who clearly need wheel chairs are now not getting them. Doctors who provide alternative medicine that is really helping their patients are being accused of unnecessary treatment, which can carry huge financial penalties or even imprisonment. More and more doctors no longer participate in Medicare because they want to offer treatments that are not usual and customary because these procedures are more effective in their experience. See Family Practice News (click here), March 1, 2012, p. 16.