Medical Device Kits Duped Medicare: Can You Help Prevent Future Fraud?

The Department of Justice is doing some old-fashioned investigative work, and it is paying off big time. “During fiscal year 2008, the DoJ’s efforts to combat health care fraud accounted for $1.12 billion in civil settlements and judgments,” reported Tony West, assistant attorney general, before the U.S. Senate Committee on the Judiciary last week. “Our monetary recoveries in fiscal year 2009 have already exceeded those of the previous year, and we appear on track to soon report over $1.6 billion in settlements and judgments in health care fraud matters.”

But do such investigations need to be so hard?

Currently, the DoJ is “actively analyzing Medicare data . . . to identify fraud hot spots and expand strike force operations.” It has “enhanced training programs on enforcement measures for prosecutors and investigators.” The DoJ also encourages the public to report fraud at www.stopmedicarefraud.gov.

I keeping wondering, though, whether serial numbers could be applied to every healthcare item—from wheelchairs to medical device kits to unit-of-use drugs–and then these numbers could be required for reimbursement. Couldn’t such definitive identification go a long way to eliminating the gray areas of our supply chains?

For instance, Medical Device Link reported that Noel Wayne Jhagroo pleaded guilty to conspiracy to commit healthcare fraud after admitting that under his firm Trucare Medical Equipment he billed Medicare for equipment and medical device kits that were never supplied to the Medicare beneficiaries. If these supplies had been serialized, however, individual records of orders and shipments could have been verified before Medicare issues any payments.

The DoJ should keep up its excellent work. Its efforts alone are a form of healthcare reform!

But medical device and pharmaceutical manufacturers could help stop defrauders from fooling Medicare in the first place by adopting item-level identification.

Daphne Allen
on Twitter @daphneallen