Retiring OIG agent: Gov't better at fraud detection, but Medicare still vulnerable

More comprehensive access to Medicare data and additional resources for prosecuting criminals have contributed to the federal government's crackdown on healthcare fraud, but fraud schemes continue to target Part D, Glenn Ferry, special agent in charge for the Department of Health and Human Services (HHS) Inspector General for the Los Angeles regional office, told the Los Angeles Times.

Ferry, who is planning to retire at the end of the month after 27 years of service, spoke to the newspaper about how fraud detection and prevention has evolved during his time with HHS and what areas are still vulnerable to abuse.

Better technology and more comprehensive access to Medicare claims data has significantly improved the way federal agents uncover fraud schemes, he said. Previously, authorities were forced to request Medicare data through contractors, slowing down ongoing investigations. Now, predictive analytics allows for a more proactive approach, and pattern recognition software has allowed fraud fighters to comb through multiple commercial databases to identify trends.

"We also have agents dedicated not just to putting criminals in jail, but these agents want to make changes to the system," Ferry told the LA Times. "They see how these criminals are beating the system. It's refreshing to see they can make recommendations now on how to close those loopholes."

Ferry adds that organized crime is still a primary player in many fraud schemes throughout the Southwest. OIG agents have found HHS press releases and articles during previous fraud raids, indicating that the criminal rings are actively keeping pace with enforcement actions.

Part D fraud remains a top concern, according to Ferry, who referred to abuse within the program as a "financial tsunami." Earlier this month, a House Subcommittee grilled representatives from the Centers for Medicare and Medicaid Services (CMS) and the OIG about fraud prevention weaknesses within the Part D program, following two OIG reports highlighting a spike in opioid prescribing. Ferry says that in addition to narcotics, expensive anti-psychotic medication and hepatitis C drugs have been conduits for drug diversion.

"Greed makes people do interesting things," he said.

For more:
- read the LA Times article

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