Fraud and Abuse
FTC to host information gathering workshop on ACO antitrust issues
Posted on May 3, 2011
The Federal Trade Commission (FTC) will host a workshop on May 9 to gather information on enforcing U.S. antitrust laws as they relate to the formation of Accountable Care Organizations (ACOs). The Department of Justice (DOJ) and the FTC issued a joint policy statement on ACO antitrust enforcement March 31, for which the comment period expires at the end of May.
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HHS Office of Inspector General’s Top Management and Performance Challenges for Fiscal Year 2010
Posted on March 18, 2011
The complexity and size of the U.S. health care system makes it susceptible to fraud and abuse in both the public and private insurance markets. According to the National Health Care Anti-Fraud Association (NHCAA), an estimated 3% of all health care spending is lost to fraud; government and law enforcement agencies have estimated fraud-related loses to be as high as 10% of annual health care expenditures. The financial ramifications of these fraudulent schemes are enormous to patients, providers and the federal government. Indeed, the U.S. Government Accountability Office (GAO) estimates that for 2010, Medicare alone had $48 billion in improper payments (underpayments and overpayments). In response to its findings, the GAO recommended that the Centers for Medicare and Medicaid Services find ways to address the vulnerabilities to improper payments and enhance program integrity.
HHS/DOJ issue annual report on fraud and abuse
Posted on January 25, 2011
The U.S. Department of Health and Human Services (HHS) and the U.S. Department of Justice (DOJ) have issued their annual report on health care fraud and abuse. The report shows that the Federal Government’s Health Care Fraud and Abuse Control Program recovered more than $4 billion of taxpayer dollars during fiscal year 2010. HHS Secretary Kathleen Sebelius said, “Thanks to the President’s leadership and the new tools provided by the Affordable Care Act, we can focus on stopping fraud before it happens.”
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CMS proposes rule screening providers and suppliers, suspending payment
Posted on November 15, 2010
The Centers for Medicare and Medicaid has proposed a rule on screening providers and suppliers in the Medicare, Medicaid, and CHIP programs and freezing payments “if necessary to prevent or combat fraud, waste, and abuse.”
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HHS report finds Medicare beneficiaries save $3,500 from reform
Posted on November 5, 2010
A new report from the Department of Health and Human Services finds that the health reform law will save beneficiaries in traditional Medicare $3,500 over ten years from reduced drug costs, improved quality, and the elimination of fraud and abuse.
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CMS grants $9 million to combat fraud
Posted on October 1, 2010
The Centers for Medicare and Medicaid Services has granted $9 million to support more than 50 Senior Medicare Patrol (SMP) Programs fight fraud. According to the agency, “The grants will provide additional funds to increase awareness of Medicare and Medicaid beneficiaries of health care fraud prevention, identification and reporting through expansion of SMP program capacity.”
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HHS issues proposed rule to stem Medicare, Medicaid, and CHIP fraud
Posted on September 21, 2010
The Department of Health and Human Services has issued a proposed rule to stem fraud in the Medicare, Medicaid, and Children’s Health Insurance Program under authority created by the health reform law.
According to the agency, the proposed rule will:
- “Establish the requirements for suspending payments to providers and suppliers based on credible allegations of fraud in Medicare and Medicaid;
- “Establish the authority for imposing a temporary moratorium on Medicare, Medicaid, and CHIP enrollment on providers and suppliers when necessary to help prevent or fight fraud, waste, and abuse without impeding beneficiaries’ access to care.
- “Strengthen and build on current provider enrollment and screening procedures to more accurately assure that fraudulent providers are not gaming the system and that only qualified health care providers and suppliers are allowed to enroll in and bill Medicare, Medicaid and CHIP;
- “Outline requirements for states to terminate providers from Medicaid and CHIP when they have been terminated by Medicare or by another state Medicaid program or CHIP;
- “Solicit input on how to best structure and develop provider compliance programs, now required under the Affordable Care Act, that will ensure providers are aware of and comply with CMS program requirements.”
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HHS releases final rules for achieving ‘Meaningful Use’ of electronic records
Posted on July 15, 2010
The Department of Health and Human Services announced final rules for achieving “meaningful use”of electronic health records so that eligible physicians and hospitals may qualify for as much as $27 billion in federal funding.
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CMS proposes rule on nursing home civil monetary penalties
Posted on July 13, 2010
The Centers for Medicare and Medicaid Services has proposed a rule that will govern civil monetary penalties on nursing homes under the health reform law. CMS is empowered to place fines collected in an escrow account, which will be returned with interest if a nursing home successfully appeals.
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Health agencies launch fraud prevention education campaign
Posted on June 8, 2010
The Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Administration on Aging have launched a one million-dollar public-education campaign to combat fraud timed to coincide with the issuing of $250 “donut hole rebate” checks created by the health reform law. This includes radio ads in English, Spanish, Korean, and Armenian.
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