November 18, 2024
Bloomberg recently published an interview featuring Jetson Leder-Luis, Assistant Professor in Markets, Public Policy, and Law, discussing his work studying government fraud, particularly in healthcare spending.
Leder-Luis highlights how fraudsters exploit government program loopholes, causing billions in waste. For example, fraudulent ambulance services bill Medicare for non-emergency rides, particularly for dialysis patients, despite attempts to curb such fraud with measures like prior authorization. While data exists to detect fraud, government efforts remain underfunded and ineffective, often focusing too much on money recovered rather than preventing fraud.
“If we do not hire and recruit excellent analysts to look at government data from the government, we are going to miss obvious frauds…We’re talking about huge amounts of billing for patients who obviously don’t need it in some of these cases and the government pays it and they miss it,” Leder-Luis adds.
Overall, government agencies face challenges like high turnover and lack of resources, which hinder effective anti-fraud efforts. While using data to detect fraud is crucial, enforcement is limited due to these resource constraints.
