Even Medicare’s Plan to Uncover Fraudulent Billing Practices is Flawed

It’s no secret that the Medicare system is flawed, with loop holes the size of the Grand Canyon that practically invite medical providers to fraudulently overbill.  When fraud is rampant, everyone suffers. Further, it seems that the Centers for Medicare and Medicaid Services (CMS) doesn’t seem to be able to catch the cheaters well enough to make sure the honest guys get paid in a timely fashion.

According to a report released by the U.S. Senate’s Special Committee on Aging, Medicare payments are higher than ever before – 10.1 percent in 2013, up from 8.5 percent the prior year. CMS has attempted to track providers that fraudulently overbill for Medicare services.

On the heels of releasing the report, the Committee on Aging publicly scolded the CMS last week, noting the agency failed to put measures in place to prevent the improper payments. Further, according to Sen. Bill Nelson (D-FL), CMS is erroneously pointing the finger at providers who haven’t done anything wrong.

“The bottom line is, despite doing more audits than ever before, Medicare just isn’t getting the job done when it comes to preventing payment errors,” said Sen Nelson. “Medicare must change the way it pays its providers so that the cheats are getting caught and the honest providers are getting paid.”

CMS has hired recovery audit contractors (RACs) to uncover the fraudulent billers. However, the Senate committee reiterated that clearly those contractors aren’t getting the job done well enough to make a dent. Therefore, the CMS was advised to focus its audits on providers who have been found guilty of making improper Medicare claims in the past. Further, the senators said, CMS should pay the RACs based on abilities to prevent improper payments from continuing.

Sen. Nelson said the incentive system for compensating the RACs is inappropriate, noting “If the goal is you want to reduce the overall amount of improper payments that’s what also ought to be what we’re going after and compensate the contractors based on that instead of on the number of improper payments that they identify.”

If you have information alleging fraudulent activity, whether in regard to Medicare billing or anything else covered by the Consumer Fraud Act, you need to speak with an experienced whistleblower attorney who can help you prove your case.

The qui tam attorneys at Begelman & Orlow, P. C. have more than 115 years of combined experience litigating whistleblower cases throughout the U.S. Contact us for a review of your case.

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