Letter to the editor by Phillips & Cohen attorney Peter Budetti discussing fraud in the healthcare system. Published in The New Yorker.
Gawande reports the welcome news that health-care-delivery systems and financing innovations since the enactment of the Affordable Care Act portend dramatic reductions in unnecessary medical care in this country. Yet an avalanche of fraud continues to harm both patients and health-care programs. During my years as the chief Obama Administration official at the Centers for Medicare and Medicaid Services responsible for fighting health-care fraud, I saw firsthand how medical fraud injures patients and diverts money away from productive uses. Competent physicians become submerged in America’s “profit-maximizing medical culture,” as the article mentions. Some provide unimaginable amounts of unnecessary care; others participate in scams that exploit a system of wasteful health-care spending. Fortunately, powerful anti-fraud provisions in the A.C.A. and other initiatives have revoked the billing privileges of tens of thousands of providers, and all Medicare claims are now screened before being paid. These measures, combined with continued financial incentives for whistle-blowers and stronger criminal penalties, will help stop the hemorrhaging of money from our health-care system and better protect all patients.
Peter P. Budetti, M.D.
June 29, 2015