Each day Medicare processes 4 million claims and pays out $1 billion. According to government experts, the federal government could save as much as $70 billion a year by cracking down on fraud. The key, they, say is preventing the crooks from doing business with Medicare in the first place — not trying to chase them down months after Medicare has paid them.
At a recent hearing before the House Subcommittee on Oversight & Investigations Omar Perez, an Assistant Special Agent with the Department of Health and Human Services (HHS) told Congress that “Medicare fraud is discussed openly on the streets and accepted as a safe and easy way to get rich quick.”
For example —in Michigan, federal authorities recently arrested a doctor for prescribing more than 5 million doses of narcotics between 2008 and 2010 and fraudulently billing Medicare for more than $5.7 million. The complaint said that the doctor prescribed controlled substances for as many as 250 patients a day, although he saw few of the patients, and that some of his patients were selling their drugs in the parking lot.
According to Lewis Morris, Chief Counsel to the HHS Office of Inspector General, violent and organized criminal networks are infiltrating Medicare. Criminals steal the identities of thousands of Medicare beneficiaries from around the country, as well as the identities of doctors. Members of the syndicate lease office space, open fraudulent clinics and open bank accounts to receive Medicare funds - - often in the name of the doctor whose identity they have stolen. Once approved as Medicare providers, the crooks bill Medicare for services never provided, using the stolen beneficiary information. Once the funds are received from Medicare, they are quickly withdrawn and laundered, and sometimes sent overseas. Although Medicare has identified and shut down some of the phony clinics, new ones often pop up in other states.
“Medicare fraud has been a long, on-going cancer that is threatening the viability of the program for seniors and the disabled,” says TSCL Executive Director, Shannon Benton. TSCL believes Congress could provide better oversight of scarce Medicare dollars by strengthening the standards for providers to keep the crooks out to begin with, improve the prepayment review of claims, and aggressively go after those who commit fraud, shut them down, and recover the funds.
Sources: “Washington Ratchets Up The Fight Against Medicare Fraud, Ken Stier, TIME, January 4, 2010. “Michigan Doc Arrested For Prescribing 5M Doses Of Narcotics,” Associated Press, March 4, 2011. “Medicare Billing Fraud Charges Get Bond Revoked For Doctor,” Detroit Free Press, March 24, 2011.