NCJ Number
42151
Journal
SOCIAL AND REHABILITATION RECORD Volume: 1 Issue: 2 Dated: (MAY 1977) Pages: 24-27
Editor(s)
M JUDGE
Date Published
1977
Length
4 pages
Annotation
THERE HAS BEEN SIGNIFICANT PROGRESS IN CURBING THE EXTENT OF MEDICAID ABUSE, BUT NOT AS MUCH AS SOME WOULD LIKE.
Abstract
COMPUTERIZATION OF THE MEDICAID SYSTEM IN SEVERAL STATES HAS BEEN A BIG HELP. THE SYSTEM CAN BE PROGRAMMED TO IDENTIFY PHYSICIANS WHO PERFORM AN ABOVE AVERAGE NUMBER OF SURGICAL PROCEDURES OR CLINICAL LABORATORY TESTS. IT CAN ALSO DETECT DUPLICATE BILLING FOR THE SAME SERVICE BY COMPARING THE TYPES OF SERVICES, DATE THEY WERE RENDERED, AND THE COST ON THE INVOICES. THE SYSTEM CAN ALSO DETECT PING-PONGING, A PRACTICE WHERE A PATIENT IS REFERRED BACK AND FORTH FROM ONE MEDICAL PRACTITIONER TO ANOTHER. ANOTHER FACTOR THAT HAS HELPED CONSIDERABLY HAS BEEN THE STRICTER ATTITUDE OF PROSECUTORS IN CRACKING DOWN ON SUSPECTED ABUSE....BDS