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Medicare fraud going unchecked, according to AP


The Associated Press released information Oct. 16 showing that Medicare, the nation's affordable health insurance provider, frequently suspends their providers in an effort to fight multiple billions of dollars’ worth of fraud each year. The report said that Medicare also very quickly reinstates the providers after fast appeals hearings that most of the providers don’t even attend.

Federal prosecutors are unhappy with the speedy reinstatements, saying they are a missed chance to punish fraudulent providers and stop future fraud. Officials did say that the quick reinstatements are good for those who get snagged on minor technicalities, ultimately helping those providers’ patients.

Security bonds were instituted two years ago to help Medicare find fraudulent providers and discourage them from disappearing at the first sign of conflict. Because Meidcare fraud amounts to so many billions of dollars, federal regulators wanted some kind of incentive for Medicare to hunt out and stop the fraudulent providers. Medicare fraud amounts to $60 billion to $90 billion per year currently. Federal officials say that millions of dollars sit unrecovered from the security bonds issued two years ago, and they blame personnel changes for the lapse.

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The report went on to say that neither federal officials or representatives of those providers being accused of fraud routinely attend preliminary hearings for Medicare fraud, allowing many to effectively win by default. Despite the Associated Press’s report, officials declined to say what the reason was for the hearings being missed.

Because Medicare fraud has become such a big moneymaker, even drug dealers have begun participating in it. Most times, Medicare fraud gives a bigger payout and less harsh sentencing than peddling traditional street drugs.

"If Medicare wants to stop fraud, it can't keep pretending these are real providers," said attorney Kirk Ogrosky, former head of the Justice Department's division of health care fraud investigations, in the Associated Press’s report. "Medicare is adept at enforcing technicalities because the system has been designed for real providers, but outright crooks go undetected because their claims appear legitimate."

Reference: AP