Government having trouble enforcing anti-fraud legislation

With the passage of the Affordable Care Act, providers who were terminated with cause from one state's Medicaid program are now no longer eligible to participate in another state's Medicaid program. This measure was supposed to reduce fraud by providers who would get caught in one state and simply set up shop in a different state. That's the theory at least.

Reuters and the U.S. Department of Health and Human Services Office of the Inspector General both conducted independent studies and found contrary to that. The Office of the Inspector General recommended that the government work to standardize terminology used by different databases so that each state can more easily detect when a provider is no longer eligible.

On one level, I sympathize with the problems of standardizing data across different sources. We at DocSpot deal with that problem frequently. On another level, though, the Department of Health and Human Services was the organization that put forth the National Provider Identifier system for the purpose of uniquely identifying providers across multiple contexts. They had to do a fair amount of work for that project, and it seems that they could have done a better job of standardizing termination terminology upfront in order to comply with legislation and reduce millions of dollars paid out in fraud.