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Bruce Sackman on Medicine, Money and Fraud

On May 16, 2017, SPI President Bruce Sackman gave a presentation to the New York External Fraud Committee, on how medical centers work to combat fraud waste and abuse in their organizations. Sackman, Senior Investigator for the Mount Sinai Healthcare System, addressed the topics of external and internal financial frauds, including Medicare Medicaid frauds, bribery, theft of equipment and supplies, employee misconduct...

The variety of frauds and motives was impressive. In New York City, some doctors can get very creative in their billings when treating foreign patients, for instance. These patients who come from all over the world to get treatment in the city’s top institutions pay cash and in advance. They often overpay for services not rendered. As they fly back home, their visits are deleted from systems. While "Phantom billing" and "Upcoding" line the pockets of corrupt physicians, other types of fraud, such as "unbundling" (charging separately for procedures that could be under one code), are often committed by salaried employees of hospitals who don’t make direct financial gain, said Sackman: "These are people who want to avoid embarrassment at meetings,  they want to 'make numbers' and hope that they will move up the ladder,” he explained.

Sackman described different laws that help combat fraud and abuse in medical facilities, such as the Stark Anti Kickback Law and the systems in place to encourage whistleblowers to come forward with information on fraud, such as Qui Tam Litigation. He also talked about external threats and the WanaCry cyberattack. “Security isn’t always a priority in hospitals. Medicine is,” he stated. That’s why ID thieves and hackers target hospitals for ransomware. “A lot of hospitals have paid ransomware, and you don’t hear about it,” he said.

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