New five-point plan for fighting Medicare fraud

December 1, 2008  |  Press Releases

The transition to Barack Obama’s new administration will include a new focus on fraud and abuse in health care. The Office of Inspector General (OIG) of the Department of Health and Human Services
recently announced a five-part comprehensive strategy to help the government fight fraud, waste and abuse. The five components of the new strategy are as follows:

First, the government should look closely at applicants seeking to enroll as medical providers before they are assigned Medicare provider numbers. By preventing unauthorized parties from billing Medicare in the first place, much health care fraud can be eliminated at the start.

Second, make sure Medicare reimbursements are tightly aligned with real world costs. When Medicare payments are excessive, it not only wastes resources, but also encourages fraud by making available funds to siphon off for kickbacks.

Third, the government should help the health care industry by making sure care providers understand how to bill properly for services. In virtually all health care fraud cases, the care providers defend themselves by arguing that they were told by Medicare contractors that it was acceptable to bill in a particular manner. This sometimes proves not to be the case. But to back up such claims where providers really were given misinformation about billing practices, the providers need to document each interaction with Medicare contractors and confirm their conversations with a follow-up email.

Fourth, the government must be vigilant in monitoring claims for Medicare reimbursement to put an early stop to fraudulent practices.

Fifth, the government must respond decisively once fraud is detected. Medicare fraud task forces have proven that such cases are not so complex that they cannot be mounted quickly. The faster cases are put together, the better chance of making a complete recovery of ill-gotten gains.

The OIG is also emphasizing use of the civil monetary penalty (CMP) in connection with cases brought under the False Claims Act. For example, the Department of Justice will use the False Claims Act to pursue a hospital for making illegal kickbacks, while the OIG will focus on the recipient of any kickbacks and impose a CMP. In that way, the OIG works in conjunction with the Department of Justice to target all aspects of Medicare fraud.

For the full story, go to AIS

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