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Medicare claims at issue

September 23, 2010
The Daily Mining Gazette

About $55 billion is paid out of the federal Medicare and Medicaid programs each year to cover improper - sometimes fraudulent - claims. Clearly, more needs to be done about that.

We applaud a new initiative to crack down on improper Medicare and Medicaid billing. It includes several steps that should reduce fraud in the program.

Among them are more visits by federal officials to companies that submit bills to Medicare and Medicaid, in order to ensure the firms are legitimate businesses that actually provide services. Another planned tactic is to require state Medicaid programs to stop using medical providers that have been rejected by the Medicare program or by other states' Medicaid systems.

One proposal deserves additional consideration, however. It would suspend payments to medical providers if there is a "credible allegation" of fraud. That includes complaints from consumers, some of whom may have personal axes to grind. "Credible" allegations need to be just that.

Medicare and Medicaid officials should not make life more difficult for reputable providers of services - but certainly need to crack down on fraud.



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