Going After Medicare Fraud

The government stepped up the fight against Medicare fraud in 2009 with 77 people going to prison and $2.5 billion recovered for the Medicare Trust fund.  The U.S. Department of Health and Human Services (HHS) announced these results and described expanded efforts to fight fraud in the Medicare system.

Medicare Fraud Strike Force teams, which are joint operations between the Department of Justice, Health and Human Services and state and local partners, have been expanded to seven communities with high levels of health care fraud: South Florida; Los Angeles; Houston; Detroit; Brooklyn, N.Y.; and Baton Rouge, La.

During Fiscal Year (FY) 2009, the federal government won or negotiated approximately $1.63 billion in judgments and settlements according to HHS.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC) which was charged with investigating and prosecuting Medicare fraud.  According to HHS, some of their recent accomplishments include:

  • Deposits to the Medicare Trust Fund totaled approximately $2.51 billion in FY 2009 as a result of these efforts, a $569 million, or 29 percent, increase over FY 2008.
  • In addition, more than $441 million in federal Medicaid money was transferred separately to the U.S. Treasury – 28 percent more than in FY 2008.
  • The HCFAC account has returned more than $15.6 billion to the Medicare Trust Fund since its inception in 1997.  During the past 3 years (2006-2009), the return-on-investment from the HCFAC law enforcement activities that form the primary focus of this annual report has averaged approximately $4 returned to the Trust Fund for every $1 of HCFAC funding provided for enforcement activities.

I wonder why there has been such an increase in the fight against Medicare fraud.  Perhaps it’s because somebody in government actually cares about this issue – finally.

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5 Responses to "Going After Medicare Fraud"

  1. Barking Spider says:

    I will believe they are interested in controlling Medicare fraud when the government puts out Durable Medical Equipment for bid.  Today, they do not and have set Usual and Customary prices for DMEs.  It may not be fraud but the government is not interested in saving money. 

  2. medicareblogger says:

    I found this on the CMS website.  Is the competitive bidding they refer to not sufficient to control costs?

    Starting in Fall 2009, suppliers will submit bids to supply certain types of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items in the competitive bidding areas to people with Medicare. In mid-2010, contracts will be awarded to suppliers that submit bids to supply items at competitive prices; that meet Medicare’s eligibility, quality, and financial standards; and that are accredited by an independent accrediting organization. These suppliers are called “contract suppliers.”In most cases, only contract suppliers will be able to provide competitively-bid DMEPOS items in the competitive bidding areas and file claims with Medicare for payment. Contract suppliers can’t charge more than the competitive bid prices, called “single payment amounts” set by Medicare for these competitively bid items. These amounts are based on the bids received for an item and can’t be higher than the current Medicare-allowed amount (fee schedule).

  3. Aaron Jeskey says:

    While the Office of Inspector General has been escalating their pursuit of these folks committing the crimes, many of the illegal claims could be avoided if more employers were using verification tools to avoid hiring and retaining known criminals.
    The service OIG Verify is being built specifically to help mitigate the risk of the employer.
    Hopefully with the good work of the OIG and the public sector supplying tools like OIG Verify, we will see a significant reduction of this fraud.

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