Posts Tagged ‘CMS’
Wednesday, March 16th, 2011
In the fight against Medicare fraud, whistleblowers remain a strong weapon in the government’s arsenal. Last year, the federal government recovered $4 billion stolen from U.S. taxpayers through Medicare fraud. Much of that money was recovered through qui tam cases initiated by whistleblowers under federal and state false claims acts.
In 2010, Medicare covered 47 million beneficiaries, and had estimated outlays of $509 billion, of which the federal government lost nearly $48 billion on improper payments for Medicare. The Center for Medicare and Medicaid (CMS)- the agency within the Department of Health and Human Services that administers Medicare- estimates that nearly 10% of all Medicare payments are fraudulent
To combat Medicare fraud, the federal government is now stressing prevention. According to Peter Budetti of CMS, the focus is now on stopping bad actors from enrolling in Medicare.
Yet, as fraudulent schemes become more sophisticated and more difficult to detect, the federal government likely has no choice but to continue its current “pay and chase” method of fighting healthcare fraud. Under the “pay and chase” method, the government reimburses Medicare claims and, then, chases down those claims which are fraudulent. As long as those defrauding the government remain one step ahead of those chasing them, whistleblowers remain a key tool in the fight against Medicare fraud.
In the coming years, the federal government is going to rely on the sharp eyes and inquisitive minds of Medicare beneficiaries. Currently, the government is asking Medicare recipients to look closely at their Medicare bills, explanation of benefits and credit reports to determine if service tests, medications, or medical equipment listed on the documents was never administered or delivered. The government is also requesting those recipients pay attention to names of unknown physicians, therapists, or other healthcare providers charging Medicare services for services allegedly performed.
Kenney & McCafferty would like to help you assess whether you have a viable whistleblower claim. If you have knowledge of Medicare fraud, call K&M for a free consultation.