On June 15, 2010, the U.S. Government Accountability Office (GAO) released a report identifying five important areas for preventing Medicare fraud, waste and abuse. The strategies in this new report, “Medicare Fraud, Waste, and Abuse: Challenges and Strategies for Preventing Improper Payments,” are: (1) Strengthening the provider enrollment process and standards; (2) Improving the pre-payment review of claims through automated pre-payment claim review; (3) Focusing post-payment claims review on most vulnerable areas; (4) Improving oversight of prescription drug plan sponsors. Develop a robust process to address resolve vulnerabilities to fraud.

The GAO strategies should be implemented by the Department of Health and Human Services and its components, the OIG and CMS. The strategies are intended to ward off fraud before it happens, something which will benefit taxpayers in the long run. Medicare and Medicaid has too long been a pay and chase reimbursement system.

For the GAO Report or information about qui tam law and Medicare fraud, contact Nolan and Auerbach, PA.