Feb. 19, 2001. States say intelligent software helps them recover money, correct honest billing mistakes and detect fraud that would go unnoticed. Physicians, though, are outraged at some states' tactics. They believe it's unfair to go back three to five years to look for fraud when most doctors have only a year to file Medicaid claims. They say the system is tainted when companies are paid a percentage of what they recover.
Doctors also question computer algorithms used to find billing errors.
In some cases, the computer program made the error, not the doctor, they say. States using outside contractors incorporate the computer audits' findings into letters sent to doctors that say how much the physicians owe Medicaid. These unexpected letters have angered some physicians. A six-inch file, a lawyer and a judge still haven't resolved the problem. It shows how out of touch the government is with the needs of patients and doctors.