Federal government seeks power to exclude those involved with health fraud from working again with Medicare

The Hill: "Independent federal investigators hoping to rein in Medicare fraud are asking Congress for broad new authority to boot offending corporate executives from the insurance program. The change is designed to control Medicare claims fraud by punishing culpable owners, managers and other corporate higher-ups, and not just the convicted companies. … Under current law, HHS can exclude from all federal healthcare programs any owner or employee who knew, or should have known, about a healthcare scheme leading to a company's conviction. But to be subject to the exclusion, the offending person must still be with the company." As a result, "[c]ulpable executives can resign — and offending owners can divest — immediately after a company's conviction", leaving Office of the Inspector General officials without power to prevent them from "participating in federal health programs with other companies. OIG wants Congress to expand its exclusion authority to include any worker — past or present — found responsible for the fraud" (Lillis, 6/15). 

The Boston Globe: A federal official told Congress Wednesday that some of the new Medicare models for reimbursing doctors and hospitals, such as those using "bundled" payments or flat fees for specific conditions increase "the danger" that providers could "cheat patients and the government by skimping on care. … The Office of Inspector General is developing plans to scrutinize new models of care to block fraud opportunities, said [Lewis Morris, chief counsel for the Office of Inspector General in the Department of Health and Human Services]. The new health care overhaul law signed by President Obama this year, he added, gives OIG investigators better tools to scrutinize Medicare computer data in a hunt for fraud" (Rowland, 6/15).

The Miami Herald/McClatchy: "State regulators, social service workers and several medical organizations are teaming up to help health care providers identify and protect older patients who are vulnerable to financial abuse and scams." The effort was announced Tuesday. "It comes as a new survey by the [Investor Protection Trust] shows that one in five Americans over age 65 -- more than 7.3 million people -- reported being victimized in a financial swindle at some point in their life. … The 'Elder Investment Fraud and Financial Exploitation' project will train medical professionals across the country to identify patients with mild cognitive impairments who are most susceptible to financial scams. The goal is to have caregivers inform state regulators about patients who pose the greatest risk for abuse" (Pugh, 6/15).

MarketWatch: The effort was created with the idea that "medical professionals are in the best possible position to not only diagnose cases where elders are being swindled but also to alert state securities regulators or what some call 'adult protective services professionals' about suspected investment fraud involving these at-risk patients. This program, a new partnership between the Investor Protection Trust (IPT), the North American Securities Administrators Association, and the National Adult Protective Services Association (NAPSA), was based on a pilot program in Texas that produced three cases resulting in fines and prison sentences" (Powell, 6/16).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.