• Government
• Profession
• Business
• Opinion
• Health

• Health reform
• H1N1
• P4P
• EMRs
• Medicare
• Liability
• AMA House
• » More

• Book Excerpt
• Business Pitch
• Meetings
• » More

• Contract Language
• Ethics Forum
• In the Courts
• Practice Management
• Technically Speaking
• » More

• Issue dates
• Regions
• Health plans
• Sections
• News briefs
• Columns
• Editorials
• Letters
• Writers
• Other years

• Search tips
• E-mail alert
• Radio
• RSS
• Mobile
• Subscribe
• Institutions
• Staff directory
• Advertising
• Permissions
• Reprints
• News media
• Site guide
• Useful links
• About
• Premium
• Contact

Doctors irked by states' tactics on Medicaid fraud

A growing number of states are using sophisticated computer programs to root out Medicaid fraud and overpayment, but doctors are furious about some approaches.

By Tanya Albert, amednews staff. Feb. 19, 2001.

• PRINT|
• E-MAIL|
• RESPOND|
• REPRINTS|
• SHARE

Medicaid programs nationwide face big budget shortfalls, and a growing number of states are turning to computers to help them make sure existing money is being spent properly.

States say intelligent software helps them recover money, correct honest billing mistakes and detect fraud that would go unnoticed.

Physicians, though, are outraged at some states' tactics. They believe it's unfair to go back three to five years to look for fraud when most doctors have only a year to file Medicaid claims. They say the system is tainted when companies are paid a percentage of what they recover.

Doctors also question computer algorithms used to find billing errors. In some cases, the computer program made the error, not the doctor, they say.

States using outside contractors incorporate the computer audits' findings into letters sent to doctors that say how much the physicians owe Medicaid. These unexpected letters have angered some physicians.

Louisville, Ky., ophthalmologist Marianne Cowley, MD, received a letter saying she owes Kentucky's Medicaid program $1,065.70. A six-inch file, a lawyer and a judge still haven't resolved the problem.

"It points out the ineptitude of the government system," said Dr. Cowley, who says her court battle wasn't about the money. "It shows how out of touch the government is with the needs of patients and doctors. It's too bad they're not appreciative of our work."

About a half-dozen states already use new technology or are developing a system to detect Medicaid overbilling and fraud. Experts expect more states will create systems as software continues to improve. [...]