整頓醫界亂象 更盼二代健保當後盾

[施肇榮]

美國是針對大藥場及連鎖檢驗中心作處理
所用的調查方法並不比台灣先進



http://www.washingtonpost.com/wp-dyn/co ... 01782.html

Health-Care Fraud to Be Targeted
New Task Force Will Focus on Costly Waste and Abuse

By Carrie Johnson
Washington Post Staff Writer
Thursday, May 21, 2009

Senior Obama administration officials launched a high-level task force yesterday to use technology to help detect and prevent health-care fraud, which robs the nation's coffers of billions of dollars each year.

Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius also directed federal investigators and prosecutors to expand special strike forces to Detroit and Houston, where "erratic" billing data suggest high levels of fraud, waste and abuse in Medicare and Medicaid programs.

Together, the actions signal the Obama administration's biggest push yet to halt fraudulent claims in programs that expend hundreds of billions of dollars a year for health care for the poor, elderly and disabled.

"When individuals and corporations cross the line, we will hold them accountable," Holder said at a news conference in Washington.

Sebelius added: "What we're talking about today is theft, plain and simple."


The announcement comes a week after the trustees who monitor Medicare's finances predicted that the trust fund that pays hospital bills for elderly patients will be depleted by 2017, a year earlier than previously expected. Medicare's eroding financial stability increases the pressure on authorities to crack down on fraud.

The Health Care Fraud Prevention and Enforcement Action Team will be composed of senior-level officials at the Justice Department and HHS. The group will use electronic claims data, as well as the threat of federal prosecution, to look for unusual billing problems.

The largest sums by far recovered by the federal government in recent years have come through Justice Department intervention in whistleblower lawsuits, many filed under the False Claims Act against pharmaceutical companies. Such settlements are on track to reach record highs for fiscal 2009, said lawyers who follow the cases.

In January, Eli Lilly agreed to pay $1.4 billion in criminal fines and civil damages to resolve allegations that it defrauded Medicaid and Medicare through improper marketing of its anti-psychotic drug Zyprexa as a treatment for dementia and other diseases afflicting the elderly, for which it was not approved by the FDA. Cases involving two related drugs marketed by other manufacturers are pending, lawyers said. False-claims cases often proceed for years under seal while prosecutors and civil division lawyers investigate.

Last month, Quest Diagnostics agreed to plead guilty and pay more than $300 million in connection with faulty test kits sold to labs across the country, one of the largest such recoveries in a medical device case.

Other major pharmaceutical companies have reserved hundreds of millions of dollars for possible settlements that could come this year, said analysts who have followed the issues. And Monday, top Justice Department officials announced that the federal government and 16 states would intervene in a major whistleblower case alleging that Wyeth overcharged the government for stomach acid drugs purchased through the Medicaid program.

Department lawyers have been sorting through a backlog of the complex cases. Under the president's 2010 budget request, the Justice Department would receive $10 million to police fraud in the bailout and stimulus programs.

"The Department of Justice has done great work," said Patrick Burns, a spokesman for Taxpayers Against Fraud, a lawyers group that represents whistleblowers. "I just wish the civil division had more people to help reel in the fraudsters already on the line, as scores of billions of dollars are waiting to be recovered from the health-care industry alone."

Tony West, new leader of the Justice Department's civil division, said in an interview this week that pursuing such cases is a high priority.

"There is an incredible amount of money that can be recovered and returned to the health-care trust fund, and that has a real impact," West said. "I think you will see stepped-up enforcement in this area. You will see proactive and assertive efforts."

Health care, he said, has the "biggest single impact on the budget" and pursuing cases in that arena is "consistent with the president's agenda on health-care reform. We are following his lead."

Staff writer Amy Goldstein contributed to this report.

[施肇榮]

整頓醫界亂象 更盼二代健保當後盾

【聯合報╱劉梅君、朱顯光／台灣醫療改革金會執行長、研發組長（台北市）】 2010.07.23 02:39 am

最近衛生署長左批公立醫院，右打醫學中心，大刀闊斧整頓醫院外包牟利、詐領保險、拒收重症及扭曲醫師體制等弊端，各界叫好。

但醫療體系積弊已久，過去衛生署多睜一隻眼閉一隻眼，甚至官員常託辭沒有完備規範授權的法律，缺乏積極作為，讓二代健保法儘速修訂通過，更具迫切性。

醫療改革需要魄力，譬如美國歐巴馬總統推全民健保，深知年總額高達六百億美元之健保詐領，必拖垮財務、帶壞醫界生態。所以三月立法通過之「保護病患與平價照顧法案」，增加Ａ健保的刑期、增加執法當局權力，加強監督參加健保計畫的業者。

反觀國內，過去健保對違規查核與資訊揭露的法規不完備，甚至出現停約醫院同址更名又繼續特約看診；各界總擔心高舉輕放，難生警惕與提醒民眾之效。

【2010/07/23 聯合報】@ http://udn.com/

看看誰引用 熱門引用排行

醫界並不反對整頓弊端
但是一定要依法行政
就好像美國歐巴馬總統推全民健保，
必須先立法通過「保護病患與平價照顧法案」，
增加Ａ健保的刑期、
增加執法當局權力。

現在台灣健保的問題出在於
主管機關配合一些團體
踰越法律授權惡搞民粹

健保局訪查、蒐證的品質太差
根本就經不起法院的審查
要不是醫師被移送、起訴後
迫不得已對簿公堂
才將真相釐清
大多數都是認賠了事

這樣的單位民眾敢賦予它過大的權力嗎?

請參考附件

[DR.HSU]

健保局的訪查、蒐證幾乎都是先入為主.先將醫師當成已犯罪在訪查蒐證.不乏誘導套口供及強詞奪理之處.

[cull n cure]

.

[施肇榮]

先將醫師當成已犯罪 再誘導套取不利醫師的口供
刑責確立 再停約 放大回推 獲取不當得利
病患被訪察 以後不敢再到這家診所看病
甚至傳出去街頭巷尾說這家診所的犯罪行為(未審先判)
每訪察一次 診所就損失一票病人及聲譽

請問施大 等法律專家
這樣是不是有 詐欺 偽造文書 毀謗 欺壓基層診所之嫌
最後法院裁定無罪 診所該如何向健保局求償呢?

附件檢察官的演講內容值得大家深思