New Federal Efforts Take Aim at Fighting Medicare, Medicaid Fraud

Article excerpt

WASHINGTON -- The new Center for Program Integrity and the Medicare Fraud Strike Force are among federal efforts aimed at combating fraud and abuse in the Medicare and Medicaid programs, top federal officers testified at a hearing of the Oversight Subcommittee of the House Ways and Means Committee.

Subcommittee Chairman Charles W. Boustany (R-La.) said he called the hearing because "without action, the problem is only going to get worse. Every dollar lost to health care fraud is a dollar not spent on patient care."

Among new federal efforts is the Center for Program Integrity (CPI). Created by the Affordable Care Act, CPI is now one of the Centers for Medicare and Medicaid Services. And among the CPI's first tasks is to implement risk-based screening for new Medicare-and Medicaid-participating providers, according to Peter Budetti, deputy administrator of the CMS's Center for Program Integrity and director of CPI.

The new rule holds high-risk providers and suppliers to a higher degree of scrutiny, based on their level of past interaction with CMS and law enforcement agencies. Certain characteristics, including exclusions by the Office of Inspector General of the Department of Health and Human Services, could bump a provider to the high-risk level, Mr. Budetti said.

The subcommittee also heard from Lewis Morris, chief counsel to the HHS OIG. Mr. Morris discussed the Medicare Fraud Strike Force, also created by the ACA. The strike force is a collaboration of the CMS, the OIG, and the Department of Justice. Since its inception in 2009, the strike force has brought charges against more than 1,000 defendants, recovering nearly $2.3 billion and shortening investigation time from up to a year to a few weeks, Mr. Morris testified.

The strike force is currently working toward securing legislation to close the loophole in the current system that prevents charging executives with committing fraud if they leave the company. …

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