Healthcare IT leaders urge industry to tackle fraud issue

Healthcare fraud doesn't even get a mention in the recently released government plan for creating a nationwide health information network.

Donald W. Simborg, MD, headed a team that worked on the problem of fraud for the Office of the National Coordinator. It's a problem that costs the healthcare system an estimated $60 billion a year at the lowest estimate, and perhaps as much as $200 billion a year, Simborg told an audience at the 3rd Annual Leadership Summit on The Road to Interoperability, held in Boston earlier this week.

Simborg chaired a follow-up panel that came up with a list of 14 specific recommendations that could be built into the review process used by the Certification Commission for Healthcare Information Technology.

"So what happened to our recommendations?" Simborg asked. "Well, it got a lot of push-back."

On some level, Simborg expected resistance. Requiring fraud protections would perhaps slow the already snail-like pace of EMR adoption - at 4 percent, compared with 90 percent in every other industrialized country, according to David Bates, MD, medical director at the Harvard University-affiliated Partners HealthCare in Boston.

"What I didn't expect was that (the Office of the National Coordinator) would totally drop fraud management from its plan," Simborg said. "What I can't understand is why we don't try to solve this problem."

"What I find astounding," said Reed Gelzer, MD, a member of CCHIT's privacy and compliance panel and co-founder of Advocates for Documentation Integrity and Compliance, "we are essentially suggesting our healthcare organizations adopt systems for which there are virtually no standards and minimal certifications. Where's the discussion of the fact that we are killing 50,000 to 100,000 people a year?"

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