Why does medical care cost so much, anyway?

Dumb question.  It doesn’t take a rocket scientist to understand that healthcare costs.  Treatments cost, prescriptions cost, equipment costs.  Everybody knows that.

Not everybody knows that bloopers cost.  Big time.

The medical field is required to dance to a dizzying array of rules and regulations, and large facilities all employ compliance officers just to make sure that they hold onto their shirts.  Smaller ones try their best to keep abreast of the law with their own small staff, all the while praying that they haven’t somehow missed or forgotten something.

Not having OIG compliance (Office of the Inspector General) means trouble.  Even if the mistake was just an innocent one.

To bring a brief illustration: In the past year alone, the OIG levied over $10.5 million in fines to medical facilities who hadn’t really done anything heinous.  They’d simply neglected to appropriately screen their employees and vendors if they are on the OIG exclusion list.

(To provide some background for the uninitiated: The OIG can exclude any particular person or business from participation in government medical programs such as Medicaid and Medicare as a penalty for a host of misdemeanors, ranging from mistreatment of patients to defaulting on a student loan.  That seems fair, right?  The catch is that any facility that contracts with an excluded provider can be fined for doing so – even by mistake.)

In an infographic released recently, Streamline Verify identified 15 types of health care programs ranging across 32 states that were slapped with fines from the OIG during the year 2014.

There are dozens (if not hundreds) of similar, compliance-related mistakes that drive up the cost of healthcare, simply because providers have to factor potential fines into their budgets when calculating their costs of care.

Can the healthcare compliance process be streamlined?  Probably not.  As long as there are lawmakers, there will always be new laws; and medical facilities will always have to stay on their toes to keep up.  On the other hand, there’s no excuse for medical providers to be negligent in their compliance policies, and become needlessly embroiled in mega-lawsuits and fines.    

Because patients shouldn’t have to pay for providers’ mistakes.