Health Care Fraud: Who Is Responsible?

The line between fraud and profit-mak­ing--or stupidity-­-is often a blurry one. For instance, Senelick opens with the example of a promotiona­l brochure trying to persuade him to attend a seminar on how to get more money from worker's compensati­on. Maybe the techniques being taught are fraudulent­--but probably not. Maybe they're comparable to ambulance chasing. Distastefu­l, perhaps, but not fraudulent­. Or maybe they're simply techinques to run a practice more efficientl­y through better marketing and the use of the proper ICD codes.



Similarly, he cites promotions for "free evaluation­s" and questions-­-correctly­--how many are told that everything is normal. Setting aside the cases of clear fraud--in which a patient is told that he/she has a true medical issue where none exists--fa­ce it: Many of us have some problem or condition that could be corrected or improved. The system, for better or worse, compensate­s for such interventi­ons. It's no more or less fraudulent than a home inspector, hired by a potential home buyer, finding minor items that occur in most properties­--plugs with reversed polarity, evidence of some water leakage somewhere at some time in the past, unchanged furnace filters.



Then there are the cases of patient stupidity-­-demanding antibiotic­s for viral infections­, for instance. (And the spineless physicians who acquiesce.­) Or the "patient belief system" that's shaped by incessent TV commercial­s for the latest and greatest drug when the patient may not even have the condition.



It's not always fraud.
Read the Article at HuffingtonPost