Medicare paid $47 billion in suspect claims
Dom
Govt: Medicare paid $47 billion in suspect claims
By HOPE YEN, Associated Press Writer Hope Yen
Sat Nov 14, 12:11 pm ET
WASHINGTON – The government paid more than $47 billion in questionable
Medicare claims including medical treatment showing little relation to
a patient's condition, wasting taxpayer dollars at a rate nearly three
times the previous year.
Excerpts of a new federal report, obtained by The Associated Press,
show a dramatic increase in improper payments in the $440 billion
Medicare program that has been cited by government auditors as a high
risk for fraud and waste for 20 years.
It's not clear whether Medicare fraud is actually worsening. Much of
the increase in the last year is attributed to a change in the Health
and Human Services Department's methodology that imposes stricter
documentation requirements and includes more improper payments — part
of a data-collection effort being ordered government-wide by President
Barack Obama next week to promote "honest budgeting" and accurate
statistics.
Still, the fiscal 2009 financial report — covering the first few
months of the Obama administration — highlights the challenges ahead
for a government that is seeking in part to pay for its proposed
health care overhaul by cracking down on Medicare fraud. While noting
that several new anti-fraud efforts were beginning, the government
report makes clear that "aggressive actions" to date aimed at reducing
improper payments had yielded little improvement.
In recent years, the suspect claims have included Medicare
prescriptions from doctors who were dead, and requests for payment for
medical supplies such as blood glucose strips for sexual impotence and
diabetic shoes for leg amputees. Patients, many of them new citizens
who barely speak English, are sometimes recruited by brokers who go
door-to-door offering hundreds of dollars for use of their Medicare
numbers.
Obama is expected to announce new initiatives next week to help crack
down on Medicare fraud, including a government-wide Web site aimed at
providing a fuller account of health care spending and improper
payments made by various agencies. The Centers for Medicare and
Medicaid Services also will launch a Web interactive next month that
will allow users to track Medicare payment information by categories
such as state, diagnosis and hospital.
According to the report, the Bush administration from 2005-2008
reported improper payments of roughly 4 percent in the fee for service
program, or about $17 billion total in 2008. Government officials at
the time, however, typically did not consider a Medicare payment
improper if the medical documentation was incomplete or a doctor's
signature was illegible. Since these were flaws that ordinarily bar
payment, that methodology drew complaints from government auditors
that the figures were understated.
For fiscal year 2009, the Obama administration began counting those
claims as improper, but was unable to complete an official tally based
on the new methodology. As a result, it officially reported improper
payments for its fee for service program at 7.8 percent, representing
a partial tally under the new formula. But it considers the unofficial
tally of 12.4 percent to be more representative.
Beginning next year, the 12.4 percent figure — or a total of $47
billion in improper payments when counting both Medicare fee for
service and managed care — will be used as the baseline estimate. The
federal report sets a target of reducing improper payments in the fee
for service program to 9.5 percent by next year, which would represent
a savings of roughly $9.7 billion.
The findings come as the Obama administration is making Medicare anti-
fraud efforts an important priority. In recent months, HHS has said it
was multiplying by 10 the number of agents and prosecutors targeting
fraud in Miami, Los Angeles and other strategic cities where tens of
billions of dollars are believed to be lost each year. The new
partnership seeks to have better sharing of real-time intelligence
data on health care fraud patterns.
Officials say they also want to increase training and outreach among
Medicare providers to reduce documentation errors, while proposed
health overhaul legislation would increase background checks on
Medicare claimants and impose stiffer penalties for false claims.
Other findings:
_In the Medicaid program for the poor, roughly $18.1 billion, or 9.6
percent of claims, are believed to be improper payments.
_Using a baseline of 12.4 percent in improper payments in the Medicare
fee for service program, HHS is setting targets of reducing fraud and
waste to 9.5 percent, 8.5 percent, and 8.0 percent, respectively, for
fiscal years 2010 through 2012.
Records released earlier this week showed that CMS for three years
ignored internal watchdog warnings about swindlers stealing millions
of dollars by scamming several Medicare programs. The agency received
roughly 30 warnings from inspectors but didn't respond to half of
them, even after repeated letters.
___
On the Net:
Government anti-fraud page: http://www.stopmedicarefraud.gov/
Rowley
That is pretty old news... I've been seeing investigative news stories
on that for years...
Martin
Dom wrote:
> http://news.yahoo.com/s/ap/20091114/ap_on_bi_ge/us_medicare_fraud
>
> Govt: Medicare paid $47 billion in suspect claims
> By HOPE YEN, Associated Press Writer Hope Yen
> Sat Nov 14, 12:11 pm ET
>
> WASHINGTON � The government paid more than $47 billion in questionable
> Medicare claims including medical treatment showing little relation to
> a patient's condition, wasting taxpayer dollars at a rate nearly three
> times the previous year.
>
> Excerpts of a new federal report, obtained by The Associated Press,
> show a dramatic increase in improper payments in the $440 billion
> Medicare program that has been cited by government auditors as a high
> risk for fraud and waste for 20 years.
>
> It's not clear whether Medicare fraud is actually worsening. Much of
> the increase in the last year is attributed to a change in the Health
> and Human Services Department's methodology that imposes stricter
> documentation requirements and includes more improper payments � part
> of a data-collection effort being ordered government-wide by President
> Barack Obama next week to promote "honest budgeting" and accurate
> statistics.
>
> Still, the fiscal 2009 financial report � covering the first few
> months of the Obama administration � highlights the challenges ahead
> Beginning next year, the 12.4 percent figure � or a total of $47
> billion in improper payments when counting both Medicare fee for
> service and managed care � will be used as the baseline estimate. The