Medicare Fraud Prevalent – Despite the Government’s Stepped-up Efforts

You can’t solve a problem if you don’t know it exists. But that’s not the case with the U.S. government and the escalating amount of Medicare fraud that is going on. Fraudsters are seemingly running circles around government officials who are chasing their own tails trying to track down and stop rings of fraud that  have been bilking the U.S. government of about $60 billion annually.

Sixty billion dollars only amounts to about 10 percent of Medicare’s spend each year. That’s, sort of, the good news. On the other hand, the Obama administration recovered a mere $4.3 billion of the stolen fund in 2013.

One might say that the government might be a bit more successful if it stepped up its efforts in reviewing the 1.2 billion Medicare fraud claims it receives every year. At present, the Centers for Medicare and Medicaid Services reviews only three million of those 1.2 billion claims every year.

Then, there are a bunch of contractors who are trying to track down this fraud for the government, as well. However, it appears that there is no game plan for these investigations and no way to keep anyone from stepping on each other’s efforts. So, the government entity responsible for manually reviewing the complaints doesn’t have enough time in a year to get through them and the paid contractors don’t have any rules to get the job done.

The head of the Center for Program Integrity, Medicare’s program for fighting fraud, Dr. Shantanu Agrawal, says antifraud strategies are top priority for his Center.  The crackdown, he added, has been limited because all efforts to sabotage fraud and bring to justice its perpetrators are, obviously, hampered by hospitals and other medical facilities that are committing the fraud. Further, every time a fraudulent act is uncovered, the accused entities file appeals that get stuck in the system, seemingly forever.

“They’ve been brought to a halt by their very success,” said Marsha Simon, an expert on health policy and legislative strategy in Washington.

One of the government’s “shooting itself in the foot” moves came in July 2014 in Miami. There was a hotline that was so successful in getting fraud tips that Medicare shut it down. The reason? There weren’t enough people to handle all the leads. Now, all calls to that hotline are being sent to Medicare’s general number where hold times can feel like two or three years.

If you believe you have some information that will lead to uncovering fraud against the government, the fastest way to get your story heard is to talk to Ross Begelman of Begelman & Orlow, P. C.. He and his experienced qui tam team of attorneys have been helping whistleblowers be heard. If your case is successful, you will be entitled to a percentage of the recovered funds.

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