Exploring Senator Coburn's Undercover Patients Proposal

By Rich Lenz, The News On 6

TULSA, OK -- Oklahoma Senator Tom Coburn's idea for "undercover patients" is not part of the just-passed Health Care Reform Bill in the U.S. House. But the program is part of the "fixes" of the bill that are still under consideration.

So how would the program work, how much would it save and what do doctors think of the idea?

Tulsa physician, Dr. John Jennings, figures he examines more than 6,000 patients every year and all of them are real people with real health issues.

But that wouldn't always be the case if Senator Tom Coburn has his way.

His idea is to hire professional undercover patients who would go to examination rooms and try and root out dirty doctors.

"You put in sophisticated, knowledgeable undercover patients and you ban people from doing tests you know are not indicated or billing the government for something that was not appropriate," said Tom Coburn.

Dr. Coburn estimates that there is $80 billion worth of Medicaid fraud every year or 20 percent of every dollar spent on the popular federal program.

"That's why private insurance only has a one percent fraud rate because they're looking at their statistical models, they're looking to see if it's appropriate and they question it before they ever pay it. Medicaid pays it and then tries to collect the money afterwards, which is silly," said Senator Tom Coburn.

Both Coburn and Dr. Jennings insist the percentage of doctors or hospitals that cheat is very, very small. Dr. Jennings says the vast amount of fraud involves organized criminals.

"There's been reports of clinics being set up that are totally fraudulent and submitting millions of dollars worth of fraud, that's where they need to go after," said Dr. John Jennings.

Though Dr. Jennings would admit, it's easier to catch a cold than catch these crooks.

"They'll be up for a short period of time, bill the money and then close that clinic and move on before they can get caught," said Dr. Jennings.

And even when they are caught, Dr. Jennings says the penalties are not harsh enough.

"The penalties for Medicare fraud are much less than those for drug trafficking and from some of the reports that are out there, it's more lucrative," said Dr. John Jennings.

While the plan hasn't made it that far, Senator Tom Coburn says retired doctors would be the obvious choice to be undercover agents.