Fraud ‘Possibilities’ Are Realities

Reed D. Gelzer, MD, MPH

I particularly enjoyed Mark Nickerson's article on fraud possibilities in your annual technology issue (“Fraud in a World of Advanced Technologies,” June 2019, http://bit.ly/2LJedBZ). I wager he's quite aware that “possibilities” are actually realities. In healthcare, the number one reason why medical claims are rejected is because of “insufficient or incomplete” documentation, which now has to take into account rampant record counterfeiting using electronic health records, as documented by several investigations and federal reports. Searching for “healthcare fraud” on the U.S. Department of Justice website will lead to a list of cases involving false claims, which must be backed by patient records now primarily in digital form.