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COTA Thoughts

Medicare Fraud Tackled

Published February 12, 2013 10:49 AM by Tim Banish

You might have seen this in the news, but the presidents federal Health Care Fraud and Abuse Program are hard at work uncovering scams in the system. In 2012 alone they were able to recover $4.2 billion from both companies and individuals who were trying to cheat the system. This was the highest three year total recovered since the inception of the fraud team sixteen years ago.


Now as much as this is good news, there are two thoughts I have on this. First if they were able to recover $4.2 billion how much fraud is really happening? My guess is double or triple that amount. It's no wonder the system is going broke.


Secondly the cost of investigating and catching the fraud costs about one dollar for every seven recovered. So of the $4.2 billion recovered it cost the government close to $750 million to recover it. Granted that is still nearly $3.5 billion in the black, but I wonder what happens to the money that is recovered? Nothing in the report I read indicates that.


The Obama administration has stated that stepping up the investigations are the first step in preventing fraud and abuse of the Medicare and Medicaid systems, an important one in the attempt to control healthcare spending. However they have also stated further efforts will be undertaken to prevent fraud, such as tougher eligibility screenings for healthcare providers and increased sharing of data through the government agency.


All good news, but I hope that the actions taken do not have any side effect for the recipients of Medicare and Medicaid. If a company has to spend more time and money to be approved to receive government funds, I'm sure that cost will only be passed down to the end user. One other thing mentioned included denial of payment for surgeries that the agency believes are unnecessary. If a Medicare person has a surgery that is later deemed unnecessary, who will end up paying?


Until next time, hope all your "Thoughts" are Good-



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