AMA: Protect Physician Identify to Limit Fraud

Health care fraud could be reigned in if more attention was paid to protecting physicians from it rather than investigating them for it. That was the general message the American Medical Association (AMA) relayed to government officials at a “National Summit on Health Care Fraud” on Jan. 28.

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder convened the summit, held at Natcher Conference Center at the National Institutes of Health, Bethesda, Md.

“Health care fraud is a significant concern to the medical community, and it takes resources away from patient care as we work to maximize the value of every health care dollar,” AMA Chair-elect Ardis Hoven, MD, said to government officials during a breakout session at the summit. “Both patients and physicians have been victims of medical identity theft and other fraudulent schemes, so it’s important that the physicians, insurers and the regulatory and enforcement communities work together to tailor ways to combat fraud.”

“One area HHS can address relates to the growing problem of physician identity theft,” said Dr. Hoven. “Physicians have no ability to control access to their National Provider Identifier (NPI), and the federal government is aware of its misuse by criminals. HHS can take immediate steps to limit access to the NPI and create a national office to help physician victims of identity theft restore their good standing.”

President Obama’s proposed 2011 budget encourages HHS to prevent, detect, and recoup fraudulent health care spending, but the way in which the agency should do so is not clearly defined.

“HHS should target areas where fraud truly occurs to be most effective instead of adding onerous burdens on physicians. The administration should establish clearly defined goals for fraud efforts to appropriately target scarce resources and better measure success. Increasing resources for outreach and education to the medical community on anti-fraud initiatives, including a clear set of mechanisms on how to report fraud, should also be a high priority.”

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