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Report points to flaws in Medicare fraud contractor system, P.2

On Behalf of | Nov 18, 2011 | Firm News, White Collar Crimes |

In our previous post, we began looking at a recently report by the U.S. Department of Health and Human Services inspector general’s office. The report, which was released Monday, revealed the difficulties federal officials face in monitoring the effectiveness of fraud detection programs which seek to prevent Medicare fraud.

As we noted last time, the problems described in report are not new, but have been addressed in the past. Critics have criticized the current system for its failure to fully address those problems.

U.S. Senators Tom Carper and tom Coburn, in an attempt to address the problem, have introduced legislation that would require Medicare officials to share fraud data with both law enforcement and contracts, and to include accuracy requirements in payment administration contracts.

Medicare officials are apparently already working to give contractors access to fraud data, though that process is not going as fast as some would like.

Part of what is making the problem harder to deal with is the way Medicare reviews claims. In times past, Medicare would pay claims first and review them later. But that method may now give too much lag time for criminals to be paid for fraudulent claims and flee authorities.

One of the suggestions made by critics of the current system is that fraud detection should be built into the claim payment system so that contractors are able to keep track of fraudulent claims immediately, thus preventing lag time.

Whatever remedial steps are taken, it is clear that something needs to be done to prevent the significant amount of fraud that goes on with the Medicare claims system.

Source: Washington Post, “Report shows federal health officials struggle to monitor myriad of Medicare fraud contractors,” November 13, 2011.