$2.5B in Medicare overpayments recovered with new fraud enforcement tools

[babylonsister]

New enforcement tools help fight health care fraud


WASHINGTON (AP) -- The government says it recovered $2.5 billion in overpayments for the Medicare trust fund last year as the Obama administration focused attention on fraud enforcement efforts in the health care industry.

Investigators have new tools this year to help crack down on health care fraud, with the Justice Department and the Health and Human Services Department working cooperatively to police companies. The newly enacted Affordable Care Act is designed to lengthen prison sentences in criminal cases and the new law provides an additional $300 million over the next 10 years for stronger enforcement. It also gives the government new authority to step up oversight of companies participating in Medicare and Medicaid.

Under the Affordable Care Act, providers could be subject to fingerprinting, site visits and criminal background checks before they begin billing Medicare and Medicaid.

To combat fraud, the act allows Health and Human Services Secretary Kathleen Sebelius to bar providers from joining the programs and allows her to withhold payment to Medicare or Medicaid providers if an investigation is pending.

In a report being released Thursday, the Justice Department and HHS say they are putting investigative resources in areas where health care fraud is especially widespread, including south Florida; Los Angeles; Houston; Detroit; New York City's Brooklyn borough; Baton Rouge, La.; and Tampa, Fla.

The result is a rising number of criminal prosecutions and the return of more stolen money to the government. At the same time, federal investigators are blocking unscrupulous companies from getting into government health care programs in the first place.

more...

http://hosted.ap.org/dynamic/stories/U/US_HEALTH_CARE_FRAUD?SITE=CONGRA&SECTION=HOME&TEMPLATE=DEFAULT

[babylonsister]

1. Whoo hoo. Good news here. Anyone interested? Not doomy and

gloomy enough?

:D

[Peacetrain]

2. That is awesome!

[mopinko]

3. hey, that's not the change i voter for!

oh, wait....

[flpoljunkie]

4. Excellent, excellent news!

[wroberts189]

5. knr

[Clio the Leo]

6. Just like he said. NT

[Dappleganger]

7. Nice move...I hate waste and fraud.

We need to spend our money wisely and make sure it goes to the right places.

[SpartanDem]

8. K&R

[DrToast]

9. Oh great! There goes my fraudulent medicare billing business

Way to go, Obama. :eyes:

[paparush]

10. Suck it TeaBaggers!

[rasputin1952]

11. $2.5 billion recovered, not "saved"...

Under the GOP this would have been a "gift" to those who ripped off the government. Looks like Boner has some explaining to do...McConnell, needs a new drool bucket.

Let the GOP try and play this to their advantage...damn losers...:rofl:

[DrToast]

12. Yep, Boner would call this a tax increase!

[rasputin1952]

13. ...

:rofl:

[Guy Whitey Corngood]

14. Motherfuckers! They're infringing upon my right to rip off the government. nt

[NJmaverick]

15. K & R!

[a kennedy]

16. any mention of this on ANY of the news programs???

:eyes:

[Igel]

17. Not much.

But it doesn't say what you get from the headline.

"For the fiscal year that ended last Sept. 30"--in other words, 9 months of Obama, 3 of *--"the federal government won or negotiated $1.63 billion in judgments and settlements, and investigators opened 1,014 new criminal health care fraud investigations involving 1,786 defendants.

"Most of those figures are up from 2008, when the government won or negotiated $1 billion in judgments and settlements, and investigators opened 957 new criminal health care fraud investigations involving 1,641 potential defendants.

"In 2008, the recoveries for the Medicare Trust Fund totaled $1.9 billion." That would be f/y ending 9/30/2008.

So it's not like it went from $0 under * to $2.5 billion under Obama. But that $600 million increase is nice, even if part didn't happen under Obama's watch.

Let's ignore the fact that there's a big element of faith in these numbers. These are settlements, not payments. Payments were probably less--but how much less we're not told. We have big settlements, who needs the cash. More talking of things that aren't as though they were.

However, why did it increase?

Here's a hint from 7/2008, just a couple of months before the fiscal year under discussion began:

"The Centers for Medicare & Medicaid Services this spring wrapped up a three-year pilot program in which "recovery audit contractors," or RACs, scoured physician and hospital claims in three states to find overpayments and to recoup those dollars for Medicare. Thrilled by the project's financial success, lawmakers ordered CMS to expand the program to all 50 states by 2010. The agency plans to choose four national contractors to administer the program this summer. A new round of audits could start right away."
http://www.ama-assn.org/amednews/2008/07/07/gvsa0707.htm

Oh. So the $1.8 billion didn't cover all 50 states, etc. Instead, coverage increased--so you might expect the amount garnered, or at least named in settlements, to increase.

Of course, if the audits were ordered under a program begun in 2008 or before, it's hard to give 100% credit to the man on watch after 1/2009. There's the rub.

Did Sebelius and specifically her appointees increase the take? Probably. But it's hard to quantify and harder yet to portion out kudos. Unless, of course, you have a really, really small set of facts.

What's indisputable is that Sebelius et al. get kudos for not discontinuing a good program. Faint praise, that. That's praise best not tendered.