Medicare Strengthening the Fight against Fraud

Medicare fraud is not a new thing.  It has, unfortunately, been going on for years.  The problem is that years ago the amount of money at stake was not nearly as high and the Medicare system was not in nearly as much trouble financially.  When you put those two factors together in today’s system, fraud is hitting Medicare harder during its most difficult time in the last 60 years.

For one thing, Medicare fraud has become a multi-billion dollar business.  There are people making multiple millions of dollars defrauding Medicare every year.  With Medicare funding being cut and with lawmakers trying to keep payments to doctors and healthcare professionals competitive enough so that they can afford to continue treating Medicare patients, just eliminating part of the fraud could provide the funding for the shortfall.

CMS, the Centers for Medicare and Medicaid Services, has been looking into the situation for quite some time now and is in the process of enhancing its anti-fraud efforts.  They have announced that they will be implementing some aggressive new steps in cracking down on fraud.

Some of the changes CMS will be making include enlisting program integrity contractors who will study billing trends throughout the Medicare system.  In doing so, when it finds providers whose billing is higher than or otherwise out of sync with the majority of other providers in their region, these providers will be audited.  Since it is impossible for Medicare to look behind every claim, this is a cost effective way to look at any red flags that are going up. 

In addition, another way that CMS will fight fraud will be to actually contact beneficiaries to be sure that they received the equipment or supplies that Medicare is being billed for and that these were the right equipment and were in good condition.  Billing will be reviewed before and after payment and physicians who order an unusually high number of the same or related item(s) will be audited and/or reviewed as well. 

These ideas alone, when implemented, should save Medicare millions of dollars.  They should also discourage some individuals from engaging in fraud, as the penalties will be quite stiff and will be handled by local, state and federal law enforcement agencies, including the FBI if necessary.  With this new program and the strength of law enforcement, hopefully fraud will decrease and the money saved by Medicare will be used to help the beneficiaries who need it.

Filed under: General-Medicare

Tags: CMS, General-Medicare, medicare billing, Medicare costs, medicare fraud, medicare programs