For the first time federal officials have new power to overhaul the system under Obama's Affordable Care Act, which gives them authority to stop paying a provider they suspect is fraudulent. The bill funds hundred of new agents to go after an estimated $60 Bil. in fraudulent claims.
Whatever your views on solving the problems of the U.S. health-care system, you’d probably agree that Medicare fraud could use some attention. Today U.S. government agencies including the Department of Justice said they were charging 94 individuals responsible for a collective $251 million in fraudulent Medicare claims. (Here’s the WSJ story.)
Kirk Ogrosky, now a partner at Arnold & Porter, is a former federal prosecutor who created and managed the Medicare Fraud Strike Force. The Health Blog chatted with him by phone and email to get his take on today’s action and on Medicare fraud in general.
The government said this is the biggest operation since the strike force started, three years ago. So it’s a big deal?
Yes. It’s enormous in comparison to Justice’s history in health care fraud enforcement.
What’s the estimated annual cost of Medicare fraud in total?
It’s a really hard question to answer, but the most used estimate is $60 billion for all federal spending on health care. That comes from outright fraud, which is what the takedown today was about, false claims such as upcoding and other things that you might consider waste.
How will Medicare fraud enforcement change under health-care overhaul?
The main way it will change is that Congress and the president will fund it in an unprecedented way. President Obama has essentially put in half a billion dollars to pay for more FBI agents, HHS agents, prosecutors, and others.
What about the fraud itself — will anything change because of the new law?
There are some new areas as part of the law, such as the insurance exchanges, where we’ll have to wait and see what happens. People who commit health-care fraud are very resilient and very fast.
Is there a typical Medicare scam, or is it all over the map?
The types of scams are very regional, because people in a given area replicate them. Criminals are not creative; they learn them — they learn what billing codes to use, how to recruit patients. In Miami, they prosecute hundreds of people for schemes involving HIV infusion, home health care and durable medical equipment. And when there’s a new rule that means Medicare is no longer paying for something, people will switch to a new type of fraud.
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