GAO Report On Medicare Fraud

On November 28, 2012, the U.S. Government Accountability Office (“GAO”) filed a report with the U.S. House Committee on Energy and  Commerce’s Health Subcommittee regarding Medicare fraud in the United States. The GAO reported that 37% of all successful Medicare fraud prosecutions involved medical clinics and suppliers of durable medical equipment — two groups that were the most commonly investigated and criminally prosecuted for Medicare fraud in the United States; that hospitals were responsible for approximately 20% of Medicare civil fraud investigations in 2010 (there were 2,339 of such cases in 2010); and, that individuals who were successfully criminally prosecuted for Medicare fraud represented approximately 11% of such cases.

For 2011, $608 million was allocated towards investigating and prosecuting Medicare fraud. Medicare fraud may cost U.S. taxpayers up to $60 billion each year. Medicare fraud schemes take many forms but the most common is fraudulent billing, which includes billing for services or durable medical equipment not provided to Medicare beneficiaries, billing for more extensive or complicated services or equipment than were actually necessary or provided (“up-coding”), billing for durable medical equipment that was medically unnecessary, not provided, or billed at an exaggerated price, and paying illegal kickbacks to Medicare beneficiaries or to Medicare providers (such as drug companies paying or providing other financial benefits to drug prescribers so that their drugs are prescribed to Medicare beneficiaries more often than they would have been otherwise).

The GAO report recommends that Medicare remove beneficiary Medicare numbers (Social Security numbers) from Medicare ID cards in order to reduce Medicare fraud and to help protect Medicare beneficiaries from having their identities stolen or compromised. The estimated cost to replace the approximately 50 million Medicare cards is $850 million. In August, 2012, Medicare told the U.S. Congress that “transitioning to a new identifier would be a task of  enormous complexity and cost and one that [would] present great risks to  continued access to health care for Medicare beneficiaries.”

It is disturbing that the full extent of the problem of Medicare fraud is still unknown and that the costs to the U.S. taxpayers for Medicare fraud can only be estimated because so much of Medicare fraud remains undetected. Those intending to defraud Medicare come up with elaborate schemes, including setting up fake shell corporations that fraudulently bill Medicare for non-existent durable medical equipment, selling and buying the names and Medicare numbers of Medicare beneficiaries so that Medicare can be fraudulently billed for services and/or equipment that are not provided to Medicare beneficiaries, and recruiting the homeless to occupy hospital beds and to receive hospital services that are then fraudulently billed to and paid for by Medicare.

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Medicare is an important social benefit that many people in the United States (mostly those 65 and over and those who are infirmed) rely upon to obtain life-sustaining medical care and medical equipment that they would otherwise have to do without. Many believe that it would be unconscionable to eliminate or substantially reduce Medicare benefits that have become so ingrained in the U.S. psyche — Medicare benefits are an important safety net that our elderly and infirmed have counted on for their peace of mind that medical care will be available to them during the years when their income is either non-existent or severely diminished. While it may be next-to-impossible politically to substantially change the way Medicare provides benefits to those presently on Medicare and for those approaching the age when they have long-expected to begin receiving Medicare benefits, it should be equally impossible politically for our elective representatives to not honestly and effectively take steps to substantially reduce Medicare fraud.

If are a Medicare beneficiary and you may be the victim of medical malpractice in the United States, you should promptly seek the advice of a local medical malpractice attorney to discuss your possible medical malpractice claim.

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This entry was posted on Saturday, December 1st, 2012 at 2:06 pm. Both comments and pings are currently closed.

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