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Medicare fraud costs CMS billions

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health policy report
Centers for Medicare and Medicaid Services (CMS)
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Medicare fraud continues to drain billions from federal coffers, though the volume of CMS overpayments and errors has fallen over the past two years, according to CMS's top official. Acting CMS administrator Leslie Norwalk told the House Energy and Commerce Subcommittee on Health that the agency has seen a significant jump in fraud and abuse over the past few years. Fraud among DME vendors, orthotics, prosthetics and supplies vendors continues to be a trouble spot, Norwalk said. For example, some of these vendors are paying kickbacks to physicians who prescribe high-cost equipment, or filing claims for equipment that is never delivered or not needed by the beneficiary. Since 1997, Medicare and fraud prosecutions has brought in $11 billion in fines and settlements since 1997. On the other hand, CMS officials testified that Medicare mistakes such as overpayments are dropping, with errors likely to hit 4.3 percent this year, compared with 5.2 percent in 2005.

To learn more about the problem:
- read this Kaiser Daily Health Policy Report item

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Comments

I urge extreme caution any time you hear the federal government claiming fraud in Medicare. Not because there is no fraud, but because the feds trot out this old horse every time they need to justify a budget cut. Clinton and Shalala were masters at it. First, they sent auditors to one home care agency everyone knew was "dirty" (and about which the industry had long complained in vain). There they found that 40% of Medicare's payments were for fraudulent claims. No surprise to anyone. But then they painted the entire industry with that 40% brush to justify a massive budget cut, from which the nation's home care network has yet to recover. In short: They lied about fraud to cut the budget. To make matters worse, they created the ironically named Operation Restore Trust, which was little more than a legalized extortion racket. The feds hired bounty hunters (who were painfully ignorant of both Medicare billing and home care) who, in turn, made baseless demands for repayment with the threat that if you tried to stick up for yourself in court, they'd come looking for much, much more. No opportunity to challenge their demands, or to correct their errors, outside of court was given. In short: They invented a Medicare Mob -- "You pay up or we break your legs." Don't say I didn't warn you.

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