2011; $608 million to investigate Medicare Fraud. Few convictions or changes implemented.Submitted by go213mph on Wed, 11/28/2012 - 13:55
NOTE: It's clear by reading this report that the cost of the investigation FAR exceeded the fines they recovered. I know medicare fraud is a huge problem but when you give a group of Government employees 600 million dollars to investigate a problem and they don't even implement their own recommendations...its obvious they want the problems to continue so they will get another 600 million the next year and the next and then next. What a joke.
What GAO Found:
Hospitals constituted nearly 20 percent of the 2,339 subjects of civil fraud cases investigated in 2010, and other medical facilities accounted for about 18 percent of the subjects. Less than 1 percent of subjects involved in civil health care fraud cases were beneficiaries of health care programs. CMS has made progress in implementing strategies to prevent fraud, and recent legislation provided it with enhanced authority. However, CMS has not implemented some of the key strategies we identified in our prior work to help CMS address challenges it faces in preventing fraud. Among others, these strategies include strengthening provider enrollment processes and standards, improving pre- and post-payment claims review, and developing a robust process for addressing identified vulnerabilities.
In fiscal year 2011, the federal government allocated at least $608 million in funding to investigate and prosecute Although there have been convictions for multimillion dollar schemes that defrauded the Medicare program, the extent of the problem is unknown as there are no reliable estimates of the magnitude of fraud in the health care industry. Fraud is difficult to detect because those involved are engaged in intentional deception. According to the Department of Health and Human Services' Office of Inspector General (HHS-OIG), common health care fraud schemes include providers or suppliers billing for services or supplies not provided or not medically necessary, purposely billing for a higher level of service than that provided, misreporting data to increase payments, paying kickbacks to providers for referring beneficiaries for specific services or to certain entities, or stealing providers' or beneficiaries' identities.
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