Fighting Fraud

April 25th, 2011 by Qui Tam

Peter Budetti, director of Program Integrity at the Centers for Medicare and Medicaid Services, has focused his attention on fraud prevention, detection, and prosecution.  On average, between $70 billion and $234 billion is lost annually due to healthcare fraud.  Obama’s administration has also committed resources to minimizing fraud.

The number one state for healthcare fraud is Florida, where many elders choose to retire.  The state is swarming with criminals looking to take advantage of Medicare fraud since it is so easy to become a provider under the government healthcare programs.  Learning how to electronically submit claims is fairly easy, and the government computers automatically generate payments.  The fraudsters don’t only include healthcare professionals; it includes drug dealers and organized crimes units as well. 

To aid is the prevention of fraud, healthcare applicants are being screened; the “high risk” applicants will be subjected to background checks and fingerprinting.  The computer programs are being revamped with new software programs which make them less vulnerable.  Hoping to deter people from these scams are tougher federal sentencing guidelines for crimes that involve more than $1 million in losses. 

Although there may be a few skeptics, Max Baucus, Senate Finance Committee Chairman, said their efforts are already paying off.  Last year the government recovered about $4 billion in losses. 

For more information see:  http://www.reuters.com/article/2011/04/13/us-usa-healthcare-fraud-idUSTRE73C2HX20110413

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