"Risk to providers is higher from the government than from patients..." What say you?

[Just Steve]

Good afternoon.

 

I am wrapping up a fourth month rotation at a family practice clinic and I had the opportunity to sit with the business manager of the clinic to discuss the business end of rural health care with an outline of what it is comprised of.

 

Predictably, the conversation included governmental oversight of Medicade/Medicare, Affordable Care Act, so on and so forth. One thing out of many that struck me as interesting was when they relayed a conversation they recently had with a lawyer specializing in medical/legal issues. This lawyer reportedly said that "the risk to providers is higher from the government than it is from patients and malpractice. With malpractice, the plaintiff has to show obvious neglect or intent to do harm. With fraud, there is no particular rule that says the provider had to intend to defraud the government. It is easier for the government to prosecute a provider for insurance fraud than it is for a patient to sue a provider for malpractice."

 

What do you think of this? Is it a valid concern? Or more of an interesting anecdote reinforcing the need for accurate, truthful documentation? I personally have not heard of a care provider being prosecuted for fraud when there was not a staggering amount of evidence to show that they were indeed purposefully diverting funds and making inappropriate documentations.

 

I know the politically correct answer is that providers will always be the patient's best advocate and will not be overly concerned with what the government thinks of their charting/documentation/charges. But is the politically correct answer the most accurate one?