Medicare Fraud

Every year, we lose billions of dollars to fraud in federal and state health care programs. Every dollar we lose to fraud and abuse is a dollar that is not available to provide home care to seniors, to treat HIV and AIDS, to immunize children, and to discover new treatments for cancer and other diseases. Some fraud schemes even pose a direct threat to the health and safety of patients. Many instances of health care fraud sug­gest that existing control systems do not work the way we imagine they should. Often the manner in which schemes are revealed suggests detection is more luck than system. Whistleblower lawsuits have exposed billing by health care providers for services not rendered, billing for products not delivered, misrepresenting services, unbundling services, billing for medically unnecessary services, duplicate billing, increasing units of service which are subject to a payment rate, falsifying cost reports resulting in increased payment to the health care provider, kickbacks, and on and on. Healthcare fraud is still going strong and this blog is intended to keep readers up to date with all healthcare fraud related news and to provide commentary when warranted. This blog also contains an array of laws and regulations concerning healthcare fraud set out in an easy to read format.

Fighting Medicare Fraud

by Nolan and Auerbach on July 30, 2009

PBS business news correspondent Jeff Yastine interviewed Marcella Auerbach for his broadcast news segment titled, “Dozens Arrested For Medicare Fraud,” which aired nationally during the July 30, 2009 nightly news cast. Marcella was also quoted in Jeff’s related news article titled, “Fighting Medicare Fraud.”

In celebration of the 44th anniversary of Medicare, the segment reported that a multi-state crackdown on Medicare fraud resulted in 32 arrests in Houston, Boston, and Miami, recovering approximately $370 million.

Marcella was quoted on the financial benefits of fraud investigations, suggesting that costs for health care reform – a topic of current heated controversy – could be significantly defrayed by recovering more money from Medicare fraud and similar healthcare violations.

Marcella pointed out that, with the Federal government’s strengthened efforts to fight Medicare fraud in particular, the system has received a $15 return for every dollar spent on investigations and prosecution.

To view the full segment, go here: http://www.pbs.org/nbr/info/local-player.html?s=nbre07s2dccq669

To read the related article, go here: http://www.pbs.org/nbr/blog/2009/07/fighting_medicare_fraud.html

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