Cops, computer analysts hunt for Medicare fraud

Published on August 16, 2014 at 3:21 AM · No Comments

The Wall Street Journal looks closely at the work of the Medicare Strike Force, which includes FBI agents and CMS workers. Meanwhile, the Government Accountability Office finds Medicare audit contractors may hammer hospitals with multiple reviews of the same payment claims.

The Wall Street Journal: How Agents Hunt For Fraud In Trove Of Medicare Data
Eleven armed FBI agents crept around a stone-and-glass house here just before dawn. An AR-15 rifle and four other guns were registered to the man in the house. … It was no drug lord. The target was a doctor who moonlighted as a movie producer with an Alec Baldwin comedy to his credit. The Justice Department charged the doctor, Robert A. Glazer, with writing prescriptions and certifications resulting in $33 million of fraudulent Medicare claims. The raid in May capped a year-long investigation by the Medicare Fraud Strike Force, a joint effort by the Justice Department and Department of Health and Human Services. Raids that day in six cities resulted in the busts of 90 Medicare providers, including 16 doctors, who were separately charged with generating a total of $260 million of false Medicare billings (Stewart, 8/14).

Modern Healthcare: GAO Finds Medicare's Audit Contractors May Duplicate Efforts
The CMS' audit contractors may overlap duties and hammer hospitals with multiple reviews of the same payment claims, according to a new Government Accountability Office report that echoes concerns the provider community has voiced for years. The GAO report looked at Medicare's alphabet soup of auditors: RACs, MACs, CERTs and ZPICs. RACs, or general recovery auditor contractors, are the most well-known and have been in place since October 2009. They review hospital claims for inappropriate payment after Medicare has already paid. Four companies-;Performant Recovery, CGI Federal, Connolly and HealthDataInsights-;serve as the Medicare RACs (Herman, 8/14).


http://www.kaiserhealthnews.orgThis article was reprinted from kaiserhealthnews.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.

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