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To the Editor: Contrary to Dr Sage's¹ claims, Medicare continues to be a fee-for-service program, with nearly 85% of beneficiaries and 90% of expenditures in the fee-for-service sector. The Health Care Financing Administration (HCFA), with fewer employees than it had when founded in 1977, deals not with "a few dozen contractors" but with 807,674 physicians, 6190 hospitals, and thousands of other providers and suppliers, who submit nearly 1 billion claims per year.

In this context, fraud and abuse enforcement plays 2 vital roles. First, it fends off petty thieves and criminal entrepreneurs who inevitably prey on a program of this size and wealth (and equally on private insurers).² Criminal prosecutions are not brought for careless billing but to address serious and inexcusable misconduct, as is clear from judicial opinions in criminal cases.

Second, civil and administrative fraud and abuse enforcement officials oversee compliance with Medicare billing requirements. Only a tiny . . . [Full Text of this Article]

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RELATED ARTICLE

Fraud and Abuse Law
William M. Sage
JAMA. 1999;282(12):1179-1181.
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