Is Technology Perpetuating Medicare Fraud?

Scott Mace, December 11, 2012

So what does this ruckus mean for Medicare? I want to make several points.

First, the authorities, including the Justice Department, will have the final judgment on this matter. I have no doubt that HMA has the resources to keep this dispute unresolved for years, if they so choose.

Second, it seems unlikely that upward of 100 employees would speak to 60 Minutes just because of their general unhappiness with the company or its technology. Some doctors do chafe at having software trying to override their judgment, but in a world of evidence-based medicine and team-based care, a certain amount of that won't be denied. The challenge is determining which of HMA's software algorithms, if any, were business-driven rather than in the best interest of patients.

Third, this episode brings to mind accusations of voter fraud caused by voting machines that lack a paper trail. HMA was able to argue that the documents produced by 60 Minutes were not HMA documents. Much like a voting machine that produces no paper record, many electronic medical records may not produce a sufficiently protected audit trail. Stories of pop-ups on screens urging admission of patients can be plausibly denied.

One would hope that the end result of all this won't be an overly cumbersome and costly new set of government regulations. After all, the days of fee-for-service medicine are numbered. Once the financial incentive to admit disappears, this avenue of fraud is scheduled to be shut off. That's a good thing, because the thought of generating a paper trail for all EHR transactions is mind-boggling.

Scott Mace

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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