WSJ Fraud-Fighting Superhero vs. Physician Villains

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Adding to the feeding frenzy, the media is piling on and doing their own healthcare fraud investigations.  Over the last month, the WSJ and Russell Adams (russell.adams@wsj.com) have published a series of articles on physician fraud and abuse based on their thorough analysis of public records.  And, now Dow Jones, the publisher of the WSJ is suing the American Medical Association (AMA) for access to full Medicare records in an effort to further expose fraud:

“The Medicare system is funded by taxpayers, and yet taxpayers are blocked from seeing how their money is spent,” said Robert Thomson, editor-in-chief of The Wall Street Journal. “It is in the interest of law-abiding practitioners that those who are gaming the system are exposed. Unless funds are used efficiently and intelligently, the health of the nation, physically and fiscally, will be undermined.” (excerpted from this WSJ article)

The best defense is a good offense.  If you want to know where the lines in the sand are being drawn, then read the links below for how the WSJ is rooting out fraud on the US taxpayers and patients’ behalf.  And, remember the adage that perception is reality.  Then, implement the processes, training and systems that prevent any of the questionable and possibly illegal behavior immediately.  If you have been lax, the past will likely catch up with you.  However, if you have been endeavoring to do the right thing, educate yourself further and ensure that you are fully and completely in line with the public’s expectations of your behavior today.

Here is how the WSJ describes their data digging:

And, how the WSJ connects the dots with ex-salesperson interviews, public promotional literature and the Medicare numbers:

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One response to “WSJ Fraud-Fighting Superhero vs. Physician Villains

  1. I am a healthcare professional – pharmacist and this is a very interesting and good article. Anything that can be shared with the public to raise awareness of fraudulent billing practices will help all of us contain the astronomical costs of American healthcare.

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