Talk:Medicare fraud

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From User talk:Rabuda[edit]

A new editor has raised a concern that our current treatment of durable medical equiptment places undue weight on a certain aspect of Medicare fraud. They said at their user talk page:

"Singling out durable medical equipment and suggesting that fraud is easy to commit in that sector is incorrect and out of date. Providers of durable medical equipment, starting in October 2009, are required to be accredited by an organization approved by the Centers for Medicare and Medicaid Services and they must post a surety bond. Federal officials have noted that because of the task force actions in places like Miami and that fraud has moved into other sectors. The durable medical equipment sector accounts for about $10 billion out of the $500-plus billion Medicare budget. It's impossible for the DME sector to account for more than a small fraction of total Medicare fraud or abuse. Using a photo of a wheelchair for the story on Medicare fraud is misleading and given today's regulatory environment where it has become hard to quality for a wheelchair, it's insulting as well. Rabuda (talk) 12:18, 19 August 2011 (UTC)"
I wanted to post that here. Jesanj (talk) 12:24, 19 August 2011 (UTC)
If DME fraud has been effectively addressed by regulation, the correct thing to do is not to remove any mention of DME fraud but to discuss both the fraud and the regulation. And if equipment has become less accessible because of that regulation, that's something that should be noted as well. But to do either of these things, we need reliable sources to support any additions. ButOnMethItIs (talk) 12:35, 19 August 2011 (UTC)
Agreed. Jesanj (talk) 12:43, 19 August 2011 (UTC)
Rabuda has cited this fact sheet from CMS but I don't see anything at first glance that says this type of fraud has been reduced, which is what has been added to the article. Rabuda, please understand the gist of what original research (OR) is. You may know from personal experience that criminals have moved on to exploit another facet of Medicare, but it would be OR for us to publish that without a source. What we write in articles needs to be published in reliable sources. Jesanj (talk) 14:57, 19 August 2011 (UTC)

Rabuda here. I don't know if this is the correct place to put this, but what follows is a quote and link to a statement by Lewis Morris, Chief Counsel, Office of Inspector General, U.S. Department of Health and Human Services (HHS) on Reducing Fraud, Waste, and Abuse in Medicare – before Committee on Ways and Means, Subcommittee on Health Subcommittee on Oversight, United States House of Representatives, revised: April 19, 2011, which underscores the point I was making. “Health care fraud also migrates: as law enforcement cracks down on a particular scheme, the criminals may shift the scheme (e.g., suppliers fraudulently billing for DME have shifted to fraudulent billing for home health services) or relocate to a new geographic area. To combat this fraud, the Government’s response must also be swift, agile, and organized.”

Also, here is a link and quote from NPR transcript from "Miami Serves As Model In Medicare Fraud Crackdown," NPR, Published: February 23, 2010, by Greg Allen. "But Medicare fraud schemes shift rapidly — in location and also in the part of the Medicare program they target. One of the first popular scams focused on durable medical equipment such as wheelchairs and walkers. Later, fraud perpetrators moved to HIV infusion clinics and, most recently, home health care." Rabuda (talk) 23:08, 19 August 2011 (UTC)

Thanks for finding those sources! I like the second one better because it talks about trends in Medicare fraud. We can still mention DME but say that it's not the "hot" fraud these days and we can mention the others. Feel free to incorporate that on top of the existing sources. Thanks again. Jesanj (talk) 01:09, 20 August 2011 (UTC)

There was an HHS strike force round up earlier this year that targeted "doctors, nurses, health care company owners and executives, and others" for fraud involving "various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment." [1] I think that reflects the current, broad scope of anti-fraud efforts and arrests, and it doesn't make sense to single out durable medical equipment in the way the article is currently written, and it's certainly misleading to illustrate the whole piece with the wheelchair photo, so that needs to be deleted. Also, the end of the second paragraph of the existing article is not supported by the facts cited. You can't conclude from the information cited that there is 9 percent "waste" in Medicare. It may be 9 percent, or higher, or lower, but "improper payment" is not the same as fraud or waste. If there is data from Dept of Justice, FBI, or HHS saying there is 9 percent waste, fraud, or abuse in Medicare, that's fine. Otherwise, it's unsupported speculation. Rabuda (talk) 04:00, 22 August 2011 (UTC)

Thanks for citing that source. There is something else about editing here I'd like to explain. Articles should be based on reliable, third-party, published sources with a reputation for fact-checking and accuracy. We're not against using primary sources (those coming from the government), but, in general, we give more weight to what secondary sources say. So, your recent edit,[2], in my opinion, removed too much stuff on DME sourced to secondary sources. We can blend the two together. Jesanj (talk) 17:00, 23 August 2011 (UTC)