Feds: We’re doing well against health fraud

Calling health care “a convoluted system that’s easy to game,” Kaiser Health News’ Andrew Villegas writes that despite recent federal proclamations of success in cracking down on Medicare fraud, CMS still needs a systematic claims review system instead of their current “ad-hoc” methods. For evidence, Villegas draws on an interview with Lou Saccoccio, executive director of the National Health Care Anti-Fraud Association.

What’s the one thing Saccoccio would like to see changed right away?

Let the the federal government share Medicare claims information with states and private insurers. “If you take all of that claims data that they have between Medicaid and Medicare and start analyzing it,” he said, “You [could] identify where problem areas are.”

The government does some of it now, he said, but strictly on an ad hoc basis. A change in that policy could allow real-time fraud identification to “stop that money before it goes out the door,” Saccoccio said.

The report mentioned above, a 72-page annual assessment of the government’s efforts to stop medical fraud conducted by the HHS Office of Inspector General, declares that about $2.5 billion came to the Medicare Trust Fund in 2009, most of it from anti-fraud work. That included $620 million from criminal fines, $482 million for “penalties and mulitple damages,” and more than a billion from “restitution/compensatory damages.” But my favorite part of the report isn’t the big ticket items, it’s the avalanche of anecdotes that comes afterward.

It’s a lot to sort through (pages 8 through 56, by my reckoning) so I’ve made the whole thing searchable here. Plug in your state or a specific pet topic (wheelchairs are particularly popular among the fraudulent claimers) and you’re likely to come up with at least one story of swashbuckling government fraud busting. Or at least what passes for “swashbuckling” in OIG-speak.

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