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Policing of Medicare Fraud Up Sharply in Past Two Years

Jun 6, 2013

In anti-fraud efforts over the past two years, the government has revoked the right of 14,663 providers and suppliers to bill Medicare, according to numbers to be released today by the Department of Health and Human Services.

This is almost two and a half times the number of revocations during the previous two years, USA Today reports. In some states, the number of revocations has quadrupled.

In addition to announcing the enforcement and recovery statistics, administration officials are announcing new efforts to involve Medicare recipients in fighting fraud. Peter Budetti, deputy administrator for program integrity for the Center for Medicare Services (CMS), said a proposed rule in a new fraud-prevention program would allow people who report fraud to earn up to $9.9 million in reward money. Before today, the maximum reward for tips leading to recovery of fraud money was $10,000. Budetti said the government’s “best weapon in fighting fraud is our 50 million Medicare beneficiaries,” and this increase in the incentive amount would “attract the kind of attention” that would make seniors aware of the anti-fraud program, according to USA Today.

In addition to the increased monetary incentive, a new, easier-to-read summary statement will allow recipients to see exactly who has billed Medicare using their identification numbers. Budetti described this as a “landmark change,” according to USA Today. Through the Medicare fraud hotline, seniors can report billing from doctors they have never seen or report other fraudulent use of their Medicare numbers. Phone calls to the hotline—between 40,000 and 50,000 last year—were crucial to fraud investigations, Budetti said.

USA Today reports that the government recovered $14.9 billion in Medicare fraud money in the past four years, due in part to provisions of the Affordable Care Act, the 2010 health care law. The law has allowed the government to analyze data for indications of fraud and to stop paying fraudulent providers. In addition, providers had to go through a reapplication process to participate in Medicare; those who failed to meet requirements, had felony convictions or were not properly licensed are no longer allowed to bill Medicare.

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