Medicare Fraud Overview

714 WordsJul 30, 20143 Pages
In 2006 1/3 (about 29%) of claims paid by Medicare for “durable medical equipment” was incorrect for fiscal year 2006. Medicare and private health insurance companies pay nearly $16 billion a year for unnecessary tests doctors tell their patients they need. An estimated $23.7 billion in incorrect payments were made in 2007 including $10.8 billion in Medicare and $12.9 billion for Medicaid. From 2000 – 2007 478,500 claims were made and paid to dead physicians, this totaled $92 million. Improper payments to individuals, organizations, and contractors in 2009 totaled $98 billion, of that $54 billion were due to Medicare and Medicaid. Clearly this is a big problem that helps cripple the economy and needs to be addressed. Because of all the fraud and over spending occurring president Obama implemented a new strategy to decrease the errors and fraud by using “payment recapture audits”. Private sector auditors will be given the latest technology and tools to audit payments made to the government. The auditors are heavily inclined to find each error as they are paid based on how many errors they discover and also regain. From 2005-2008 three states, NY, CA, & TX, participated in a trial run program by Medicare in which $900 million was regained from errors or fraud. Department of Health and Human Services (HHS), as of Sept 14, 2011 ruled that the Medicaid Recovery Audit program go into effect. This is a key part of Obama Administration’s plan to reduce waste, fraud and abuse. This audit program will help all states identify and regain improper Medicaid payments. This program will majority be self-funded, paying the auditors fee out of any improper payments they uncover and regain going back 3 years. There are new tough rules and sentences for those who feel like they can get away with Medicare fraud also. The new act entitled the Affordable Care Act, also

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