Medicare Strike Force Tries New Tactic

Federal authorities have adopted a new enforcement strategy to put pressure on Medicare fraudsters. The new practice, known as "Medicare payment suspension," played a key role in a recent government strike force involving an alleged $452 million in Medicare fraud.

The idea behind Medicare payment suspension is simple: Cut off Medicare payments to healthcare providers who are under investigation for fraud. Previously, a provider could continue to bill Medicare and receive Medicare payments while the investigation was underway. The government had to fight an uphill battle to recover payments it had made to providers later found to have committed fraud. According to Department of Justice officials, Medicare's upfront payment system made Medicare fraud particularly attractive to organized-crime operations. Now, the government has authority to withhold payments to suspicious providers if there is sufficient evidence of fraud. Authorities hope that the new policy will eliminate some incentives to commit fraud in the first place.

In the strike-force operation that led to the arrests, accused healthcare providers made cash payments to a series of co-conspirators to work the Medicare system. First, providers used paid recruiters to steer Medicare recipients their way. The providers then paid the "patients" to make claims for high-end services and medical equipment.

Critics of the new payment-suspension policy are concerned that innocent healthcare providers could get caught in the enforcement dragnet. The intricacies of Medicare billing can give rise to honest mistakes that healthcare providers worry could trigger a fraud flag on their accounts. Many providers are signing up for Medicare compliance training for their staff to instruct them in the essentials of Medicare compliance.

Categories: Healthcare
Tags: Healthcare Fraud and Abuse, Medicare Fraud