Sanctioned providers still reaped Medicare dollars

Medicare paid more than $6 million in 2012 to doctors who were thrown out of Medicaid, indicted or charged with fraud, or had settled false claims allegations, according to reports co-published by ProPublica and National Public Radio.

While it's only a fraction of the $77 billion Medicare publicly reported paying for Part B services in 2012, dollars paid to problem providers represent a blind spot in federal efforts to shield the program from fraud and abuse, the article noted.

"If you've been suspended or terminated in one of the federal programs ... I would think that you'd be suspended in the other programs, just as a basis of good practice," Louis Saccoccio, CEO of the National Health Care Anti-Fraud Association told ProPublica.    

But even a guilty plea wasn't enough to stop Medicare payment from flowing to an aberrant provider, the publications stated. Louisiana doctor Anthony Jase pleaded guilty to two counts of healthcare fraud in October 2011; yet he still collected more than $97,000 from Medicare in 2012. He was sentenced last fall to 15 months in prison and ordered to pay more tha $360,000 in restitution.

What's more, the $6 million may be a deflated figure since few states post names of Medicaid-terminated doctors in a way that can accurately match them to Medicare reimbursement data.

Though analysis of publicly-released Medicare data exposed payments to problem providers, it's concerning that federal regulators have long had access to this information, the publications noted. "They're the ones doing the paying," Saccoccio said.

But Medicare's reimbursement data may not reflect money already recovered or withheld from providers suspended from billing, government spokesman Aaron Albright told the publications.

Overall, "there's been a disconnect between Medicaid and Medicare on problem providers," Sen. Chuck Grassley (R-Iowa) said in an email to ProPublica. "The release of Medicare billing data should help force better communication between Medicaid and Medicare on these providers. The new transparency makes it harder to ignore when doctors who harm patients or defraud taxpayers in one program face no consequences in the other program."       

For more:
- here's the ProPublica article
- read the NPR article

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