Advances in data analysis technology are effective in controlling Medicare and Medicaid fraud

Published on February 20, 2014 at 8:36 AM · No Comments

The annual bill for Medicare and Medicaid fraud hit 11 digits in 2012. That's tens of billions.

The numbers might be daunting, but University of Cincinnati research shows that recent strategies to combat this unique form of white-collar crime are increasingly effective.

"Estimates show that Medicare and Medicaid fraud cost somewhere in the range of $29.8 billion to $99.4 billion in 2012," says Michael T. Czarnecki, a doctoral student in UC's College of Education, Criminal Justice, and Human Services. "This means that every day in 2012 Medicare and Medicaid fraud averaged between $81.5 million and $271.5 million, with every hour averaging between $3.4 million and $11.3 million lost to fraud. But the evolution of fraud control strategies has demonstrated some effectiveness in combating this problem."

Czarnecki will present his research "Medicare Fraud: The Controllers are Fighting Back" at the Academy of Criminal Justice Sciences (ACJS) annual meeting to be held Feb. 18-22 in Philadelphia. The ACJS is a 50-year-old international association of scholars and professionals dedicated to promoting criminal justice education, research and policy analysis. Czarnecki's research reviews what's known about Medicare and Medicaid fraud and how it's controlled, especially how control strategies have evolved during the past decade.

Medicare loses billions of dollars to fraudulent claims every year, according to U.S. Department of Health and Human Services and the Department of Justice. Some examples of Medicare fraud provided by these departments include: a health care provider bills Medicare for services you never received; a supplier bills Medicare for equipment you never got; and a company uses false information to mislead you into joining a Medicare plan. Ultimately, the fraud raises health care costs for everyone.

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