HHS steps up fight against Medicare fraud

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Under new rules announced Monday, the federal government will ramp up its fight against Medicare fraud, as mandated by part of the Affordable Care Act, according to a speech made by HHS Secretary Kathleen Sebelius.

The announcement was made after a year in which providers were busted for making hundreds of millions of dollars worth of false Medicare claims, and after the feds recovered a record $2.5 billion related to healthcare fraud.

Among changes, screenings for healthcare providers who want to be paid through Medicaid or Medicare will become more stringent."The days when you could just hang a shingle and start billing the government are over," Secretary Sebelius said in a briefing.

Other changes include:

  • Better data sharing across agencies making it easier for law enforcement to identify suspicious patterns, because they will be able to see healthcare claims information from different government agencies all in one place.
  • Higher penalties for fraud.
  • Cutting the flow of Medicare and Medicaid payments to suspected criminals when an investigation is pending. The new law requires states to withhold payments to Medicaid providers during pending fraud investigations.
  • HHS sinking $350 million into hiring more people to fight fraud.

The new rules represent a slight shift away from the "pay-and-chase" approach that gives criminals a head start with what Sebelius called "a more proactive approach" that focuses on preventing fraud before it happens.

To learn more:
- read the rule here or here
- read the HHS fact sheet
- here's the HHS press release
- read Secretary Sebelius' speech

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