These days, fraud seems to be part of all major human enterprises. Did you know that fraud costs the U.S. federal Medicare program an estimated $60 billion a year? (Medicare is the federal health insurance program for those over 65 or disabled; Medicaid is the state/federal program for low-income families with children, the disabled and the poor.) Last year the feds recovered a record amount of fradulent payouts—$4.1 billion. But that still leaves a large gap.
Why you should care: Fraud not only drives up costs for everyone in the health care system, it hurts the long-term solvency of Medicare and Medicaid and the millions of Americans who rely on them. A disturbing paragraph in Wikipedia alleges that South Florida drug dealers are now making more money off Medicare fraud than smuggling drugs (although I have to point out there are no citations to support this statement).
A recent article in the Spokane-Spokesman Review says that, following federal changes, and in imitation of the private financial sector, a bill is on the table in Washington State to move away from the “pay and chase” model of dealing with fraud. Instead, “predictive technology” would be used to flag suspicious-looking claims early and submit them to further scrutiny. The change would add complicated computer programs to beef up prevention.
According to the Spokesman, the bill is “not expected to hold up payments to providers that would roll downhill and hurt patients.” The writer adds, “In other words, it’s a real attempt to do more than just talk about waste and abuse. Without abusing the wrong people.” If Washington State votes the bill into law, it would become the first state to do so, although others may follow suit.
You can report suspected Medicare fraud to the Office of the Inspector General 1-800-HHS-TIPS (1-800-447-8477). Florida residents may call a special hotline at 1-866-417-2078. For more information on Medicare fraud, and what you can do to prevent it, contact http://www.medicare.gov/fraudabuse/howtoreport.asp.