Medicare boosts anti-fraud efforts, but problems are still rife

Medicare officials recovered about $19.2 billion in fraudulent payments over the past five years, including $210 million through a new system that uses analytics to probe billing patterns, CQ Healthbeat reports. But the recovered sum is dwarfed by the size of the problem, projected to be up to $50 billion a year.

CQ Healthbeat: Medicare Anti-Fraud Efforts Said To Be Dwarfed by Scope of Problem
Medicare officials recovered about $19.2 billion in fraudulent payments over the past five years, including $210 million through a new system that tries to predict and stop fraud before it occurs, according to a federal report issued Wednesday. But the recovered sum is dwarfed by the size of the problem: Medicare makes up to $50 billion per year in improper payments, including fraud, a Government Accountability Organization official testified at a House hearing. The Centers for Medicare and Medicaid Services needs to do more to curb fraud and wasteful spending, according to GAO Director of Health Care Kathleen M. King, who appeared before the House Energy and Commerce Subcommittee on Oversight and Investigations hearing (Adams, 6/25).

The Hill: Medicare Says Predictive Analytics Working To Fight Fraud
The Obama administration announced Wednesday that a new anti-fraud program in Medicare doubled the improper payments it identified or prevented this year. The Fraud Prevention System at the Centers for Medicare and Medicaid Services (CMS) recovered or prevented more than $210 million of improper payments in its second year, the agency told Congress in a report. The program, which uses predictive analytics to analyze billing patterns, also prompted CMS to take action against 938 providers and Medicare suppliers (Viebeck, 6/25).