Medicare Fraud Squads Wield New Weapons

KHN: By Sarah Varney KHN Staff Writer AUG 21, 2012

Fighting health care fraud in the U.S. can seem like an endless game of whack-a-mole. When government fraud squads crack down on one scheme, another pops up close by. But the fraud squads who look for scams in the federal Medicare and Medicaid programs have some new weapons: tools and funding provided by the health law.

Medicare and Medicaid pay out some $750 billion dollars each year to more than a 1.5 million doctors, hospitals and medical suppliers. By many estimates, about $65 billion dollars a year is lost to fraud.

“For a long time we were not in a position to keep up with the really sophisticated criminals,” saidPeter Budetti, who oversees anti-fraud efforts at the Centers for Medicare and Medicaid Services. “They’re not only smart, they’re extremely well-funded. And this is their full time job.”

And their creativity is endless. Criminals use real patient IDs to bill for wheelchairs that were never delivered or exams never performed. Dishonest doctors – a small percentage of physicians, to be sure – charge for care they never deliver or perform unnecessary operations. In one scam, criminals bill Medicare and a private insurer for the same patient. Read More