Administration officials are patting themselves on the back for tracking down Medicare fraud, but the real problem is ineffective claims scrutiny and management that allows fraudulent claims to occur over a six-year period as described below.
The problem is that to keep everybody happy with their single payer health care, the system follows a pay and pursue policy on claims. Pay everything and later ask questions. However, wouldn’t you think that with today’s technology that patterns of abuse with regard to billing, services provided and medical necessity could be tracked and questioned in months rather than years and years?
Excerpt from The Fiscal Times 12-18-15
In the latest government blow against rampant Medicare fraud, two doctors and a registered nurse in New Orleans were given stiff prison sentences and millions of dollars in fines this week in federal court for their roles in a long-term $50 million scheme.
The trio and a fourth defendant were convicted of submitting roughly 8,000 fraudulent Medicare claims over a six-year period for referring patients to Memorial Home Health Inc. and three other “sham companies” for “medically unnecessary” home health services and treatment, according to a federal indictment reported by The Times-Picayune. In many cases, the treatments were never rendered.
Related: Audit Uncovers $124.7B of Overpayments and Fraud in Medicare and Medicaid
The blatant rip-off of the federal health care program for seniors in New Orleans would be startling if it wasn’t for the fact that it has become almost commonplace throughout the country. In 2014, federal authorities recovered roughly $5.7 billion in healthcare fraud cases, or $1.9 billion more than recovered the prior year. Of that amount, $2.3 billion was linked to healthcare fraud against the federal government, according to a recent review by the firm ofBass, Berry & Sims PLC in Nashville.
“This marks the fifth consecutive year in which healthcare-related recoveries exceeded $2 billion – and that doesn’t include state recoveries for Medicaid fraud. We don’t expect this enforcement trend to slow down any time soon. In fact, all signs point to increased enforcement in the year to come,” Brian D. Roark, head of the firm’s Healthcare Fraud Task Force, said in a statement.
As it draws to a close, 2015 is likely to be another banner year for Medicare and other health care fraud, according to the Justice Department. There has been a host of major fraud news this year involving dozens of individuals amounting to millions in abuse, often related to Medicare fraud.
Earlier this year, Attorney General Loretta E. Lynch and Health and Human Services Secretary Sylvia Mathews Burwell announced a nationwide sweep led by a “Medicare Fraud Strike Force,” The federal crackdown in 17 regions resulted in charges against 243 doctors, nurses and other health professional for allegedly taking part in Medicare fraud schemes involving $712 million in false billings.
“Those are extraordinary figures, and they reflect our administration-wide commitment to safeguard precious public resources, to rid our health-care systems of fraud and abuse, and to sustain the integrity of programs that are essential to the public welfare,” Lynch said at a June 18 press conference. “In the days ahead, we will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives.”
As of Sept. 30, the strike force had taken 1,387 criminal actions producing 1,977 indictments and involving $1.8 billion of fraudulent activity, according to the Department of Health and Human Services Inspector General’s Offices.