Medicare fraud costs the U.S. more than $60 billion annually, and for years, the traditional way of catching it has been the "pay and chase" game, or trying to recoup losses after scam artists have already cashed in, according to a story by Kelli Kennedy and Ricardo Alonso-Zaldivar.
Nearly 50 million Americans relied on Medicare for a cost of $557.8 billion in 2011 – an increase of 6.3 percent – and it’s only expected to go up with the aging of the Baby Boomers.
But the U.S. is no longer standing back. The story noted that Medicare's investigators are going high-tech, with the opening of a $3.6 million command center that features a giant screen and the latest computer and communications gear to keep people working on the problem in touch around the world.
Fraud czar Peter Budetti told reporters on a tour this week that the command center could be the tipping point, however, Kennedy and Alonso-Zaldivar reported. “It brings together in real time the geeks running Medicare's new computerized fraud detection system with gumshoes deployed around the country,” they wrote.
Even the Obama administration is getting into the act. The new healthcare law increases federal sentencing guidelines for healthcare fraud offenses by 20 to 50 percent for major fraud crimes. The Obama administration announced in May that it had charged 107 individuals for nearly $500 million in false Medicare billings as a result of recent efforts against fraud.
Two Republican senators, however, aren’t so sure.
Kennedy and Alonso-Zaldivar noted in their story that Utah's Orrin Hatch and Oklahoma's Tom Coburn say that “Medicare's new computerized fraud detection system, a $77-million investment that went into operation last year, is not working all that well.” In a letter to HHS Secretary Kathleen Sebelius, they questioned – and probably, rightfully so – spending millions more on a command center, “at least until the bugs get worked out.”
You can see from this anecdote supplied by the writers why they might have a point. The government's new antifraud computer system, launched last summer, was intended to adapt tools used by credit card companies to stop theft from Medicare and Medicaid. But by Christmas, it had stopped just one suspicious payment from going out for $7,591. Administration officials say that shouldn't be the only yardstick, and that the system has made other valuable contributions.
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Edited by
Allison Boccamazzo
