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Medicare’s procedures for screening doctors are faulty, report says

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h4031 (Published 23 July 2015) Cite this as: BMJ 2015;351:h4031
  1. Michael McCarthy
  1. 1Seattle

Despite recent improvements, Medicare’s process for screening out potentially dishonest or banned doctors often falls short, an investigation has found.

Medicare, the federal health insurance program for people 65 years and older and the permanently disabled under age 65, has estimated that about $60bn (£38bn; €55bn) a year (roughly 10% of its budget) is paid out improperly. As part of its effort to prevent potentially fraudulent healthcare providers and suppliers from participating in the program, Medicare uses four screening procedures.

Investigators from the US Government Accountability Office, an investigative agency of the US Congress, found that two of the screening procedures work well: a procedure set up to identify providers and suppliers who have been banned from participating in federal programs or health related programs because of prior misconduct and a procedure that identifies providers and suppliers who have died.1 But they …

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