HHS proposes bigger reward for fraud tipsters

Medicare is dramatically upping the ante on Medicare fraud, increasing the reward for tips leading to the recovery of fraudulently obtained benefits to $9.9 million--up from just $1,000 today.

The proposed rule expands the Medicare Incentive Reward program to pay tipsters 15 percent of the recovered overpayments up to the first $66 million recovered. It is modeled on an Internal Revenue Service program that has returned $2 billion to the Treasury since 2003, according to the U.S. Department of Health & Human Services.

The rule also would give HHS the authority to deny enrollment of providers affiliated with a group with unpaid Medicare debt, and deny or revoke Medicare billing privileges to convicted felons.

HHS estimates the program will increase overpayment recoveries by $24.5 million per year.

"Today's announcement is a signal to Medicare beneficiaries and caregivers, who are on the frontlines of this fight, that they are critical partners in helping protect taxpayer dollars," HHS Secretary Kathleen Sebelius said yesterday in a statement.

Medicare also is expanding the Senior Medicare Patrol, a national program focused on preventing and reporting Medicare fraud, waste and abuse. The Centers for Medicare & Medicaid Services has received more than 7,000 referrals for investigation through the group since 1997. The agency's Administration for Community Living has issued a new funding opportunity offering up to $7.3 million in funding for 54 exiting patrol projects.

In November, the HHS Office of Inspector General reported to Congress that it expected a record $6.9 billion in Medicare and Medicaid recoveries for fiscal 2013, which ends Sept. 30. Investigations by a Medicare fraud strike force led to charges against 305 individuals or entities, 181 convictions and $151 million in investigative receivables, OIG said.

In one high-profile case last October, CMS charged 91 people in seven cities with alleged Medicare fraud totaling $429.2 million. Those arrested included doctors, nurses and other licensed medical professionals, as well as healthcare business owners.

To learn more:
- here's the proposed rule (.pdf)
- read the announcement
- check out the funding opportunity announcement (.pdf)

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