Nighthawk62
Member
- Nov 20, 2010
- 42
- 9
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Are our members aware a major health care cost driver is fraudulent claims in the Medicare system? The government does not have good fraud detections and prevention systems like many companies do in the private sector. Some estimates show fraudulent claims submitted by unscrupulous doctors and hospitals account for about 25-30% of our Medicare costs.
In a recent Detroit case alone, the alleged Medicare fraud was estimated at $50 million. Those charged included doctors, health-care executives and beneficiaries. The scheme in Miami allegedly used fake storefronts in an attempt to cheat Medicare out of $100 million.
The suspects charged in the Detroit operation allegedly submitted bogus Medicare claims for care that was medically unnecessary and often not provided at all. In some instances suspects paid patients to go along with the scheme, the Justice Department, the Federal Bureau of Investigation and HHS said at a joint news conference.
Since March 2007, the government's special antifraud teams have produced more than 250 indictments involving Medicare claims totaling more than $600 million in such Medicare-fraud "hot spots" as South Florida, Los Angeles and Detroit, where abuses of the federal health program for the elderly and disabled are more frequently found.
The administration and Congress are tackling the problem of how to pay for legislation to overhaul the nation's health-care system. They want to reduce waste and fraud and use the money to help pay for expanding coverage to the uninsured. The latest budget request includes $311 million in additional funding to combat fraud.
The U.S. spends more than $2.2 trillion on health care, including more than $800 billion on Medicare and on Medicaid, the joint federal-state program for the poor. The sheer size of the health-care system makes it prone to fraud and abuse, Ms. Sebelius said. By some estimates, more than $60 billion each year is lost to fraud. Attorney General Eric Holder said frauds "contribute directly to rising health-care costs that all Americans must bear."
The government routinely prosecutes people for Medicare abuse, generally months after the fraud was committed. Officials said the expansion of specialized fraud teams led to faster indictments in recent months.
Source: U.S. Charges 61 in Medicare Crackdown - WSJ.com
In a recent Detroit case alone, the alleged Medicare fraud was estimated at $50 million. Those charged included doctors, health-care executives and beneficiaries. The scheme in Miami allegedly used fake storefronts in an attempt to cheat Medicare out of $100 million.
The suspects charged in the Detroit operation allegedly submitted bogus Medicare claims for care that was medically unnecessary and often not provided at all. In some instances suspects paid patients to go along with the scheme, the Justice Department, the Federal Bureau of Investigation and HHS said at a joint news conference.
Since March 2007, the government's special antifraud teams have produced more than 250 indictments involving Medicare claims totaling more than $600 million in such Medicare-fraud "hot spots" as South Florida, Los Angeles and Detroit, where abuses of the federal health program for the elderly and disabled are more frequently found.
The administration and Congress are tackling the problem of how to pay for legislation to overhaul the nation's health-care system. They want to reduce waste and fraud and use the money to help pay for expanding coverage to the uninsured. The latest budget request includes $311 million in additional funding to combat fraud.
The U.S. spends more than $2.2 trillion on health care, including more than $800 billion on Medicare and on Medicaid, the joint federal-state program for the poor. The sheer size of the health-care system makes it prone to fraud and abuse, Ms. Sebelius said. By some estimates, more than $60 billion each year is lost to fraud. Attorney General Eric Holder said frauds "contribute directly to rising health-care costs that all Americans must bear."
The government routinely prosecutes people for Medicare abuse, generally months after the fraud was committed. Officials said the expansion of specialized fraud teams led to faster indictments in recent months.
Source: U.S. Charges 61 in Medicare Crackdown - WSJ.com
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