Practitioner fraud and abuse: a public policy status report

In summary, a public policy to get rid of practitioner fraud and abuse has been established. It resulted initially from the changing attitude of the electorate on spending for social as well as health service programs. It is reflected by the congressional enactment of new laws against practitioner fraud and abuse, i.e., the Medicare-Medicaid Anti-Fraud and Abuse Amendments of 1977 and the Civil Money Penalties Law of 1981. It has been implemented through the prosecution of numerous practitioners involved in fraudulent activities and abuses using the new laws as well as many others, including the False Claims Act of 1963 and the fraud penalties codes recognized under the Federal Old Age, Survivors and Disability Insurance Act. The ultimate success of this public policy, however, will certainly depend, at least in part, on our ability to obtain an objective and realistic analysis of the degree of fraud and abuse in these programs, as well as to define the characteristics of "Medical Mills" and to determine to what extent they still exist. Finally, if this public policy is to mature, it must follow a path that assures that we do not disrupt or hamper the delivery of health care services to our poor and elderly populations through the needless introduction of regulatory requirements or legal excesses.