Medicare Fraud Fighters Get New Funding and Tools

The Affordable Care Act has provided new funding and tools to fight Medicare and Medicaid fraud.  Federal fraud investigators now use sophisticated computer systems to crawl through and analyze massive amounts of data – four million Medicare claims per day – looking for anything out of the ordinary. The systems, which are similar to those that credit card companies use to flag suspicious purchases, allow fraud fighters to focus more on preventing fraud rather than trying to track it down after it occurs.

Medicare/Medicaid fraud is a significant problem that costs taxpayers an estimated $65 billion per year. Examples of types of fraud include providers billing for services that were never delivered, equipment suppliers billing for equipment that was never sent, or providers billing both Medicare and private insurance for the same procedures.

The head of the anti-fraud efforts at the Centers for Medicare and Medicaid Services recently told National Public Radio (NPR), “For a long time we were not in a position to keep up with the really sophisticated criminals.” Now, he says, the new programs give them such detailed information that they are able, for example, to “verify whether a person was being treated by two different physicians in two different states on the same day.”

NPR says that Congress will give an additional $340 million to fight Medicare/Medicaid fraud over the next decade. The new efforts seem to be bearing fruit already. The number of fraud defendants has jumped sharply in the last year.

WeComply’s 35-minute online healthcare fraud and abuse course explains key real-world compliance issues, including gifts, rebates, administrative fees, purchasing from customers, educational grants and possible penalties.

Categories: Healthcare
Tags: Healthcare Fraud and Abuse