Medicare Fraud Fought With New Tools

Medicare Fraud

Medicare fraud being fought with new tools

The Affordable Care Act, widely called “Obamacare,” provides new tools and funding for combatting Medicare fraud and Medicaid fraud.  The purpose is to reduce the costs of fraud to the government and taxpayers.  NPR explains:

Medicare and Medicaid pay out some $750 billion each year to more than 1.5 million doctors, hospitals and medical suppliers. By many estimates, about $65 billion a year is lost to fraud…. Criminals use real patient IDs to bill for wheelchairs that were never delivered or exams never performed.  Dishonest doctors — a small percentage of physicians, to be sure — charge for care they never deliver or perform unnecessary operations. In one scam, criminals bill Medicare and a private insurer for the same patient.

Obamacare funds new computer systems to detect fraud and well as additional manpower.  The new computer program will crawl medicare claims to search for unusual increases in particular medical procedures or medical equipment.  Since there are nearly 4 million Medicare claims a day, computers have a tremendous amount of data to work with.  It’s estimated that the government will spend over $340 Million over the next decade in additional anti fraud efforts.

Rather than paying for claims and then pursuing fraudulent claims, the government is also moving toward a fraud prevention model.  The goal is to stop the Medicare fraud before it happens.  The government report that the new approach is working.  Non-profit groups that monitor Medicare fraud efforts think the government needs to put more investigators on the street.  They argue that investigations on the ground can be more effective than looking at a computer screen.

Source:  NPR

How Americans Can Help

The government cannot fight Medicare fraud alone.  It depends on ordinary citizens to report fraud.  It offers generous whistleblower incentives in return.   See an example of a whistleblower reward here.  To talk to a Medicare whistleblower attorney, contact us.

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