Medicare fraud detection system disappoints


A computer initiative to stop fraudulent Medicare billing at the point of claims submission has so far been a disappointment, reported the Associated Press.

To date, the $77 million computer system, which went online in mid-2011, had prevented exactly one bad claim by late last year. That totaled $7,591.

However, Medicare officials say that the holistic value of the system is far greater than that.

"Suspending payments is only one way of stopping the money," said Ted Doolittle, deputy director of Medicare's anti-fraud program.

"There's lots of ways of stopping the money, and we are using them all. Looking at payment suspensions only--that's an unsophisticated view that doesn't give you a full picture of our activities."

The U.S. Department of Health & Human Services and the Justice Department earlier this month touted a record-breaking recovery year. Fraud prevention and enforcement efforts led to nearly $4.1 billion in recovered judgments in fiscal year 2011, according to its annual report.

The computer system in question monitors virtually all Medicare claims submitted electronically--about $1 billion a day. However, it can only suspend a payment if there is reliable information that a claim is incorrect.

According to Sen. Tom Carper (D-Del.), Medicare has to "explain to us clearly that they are implementing the program, that their goals are well-established, reasonable, achievable, and they're making progress. We're not sure if they've done those things." Carper chairs a subcommittee that oversees federal financial management.

To learn more:
- read the Associated Press article in The Washington Post

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