Magazine article Drug Topics

CMS Launches Anti-Fraud Program

Magazine article Drug Topics

CMS Launches Anti-Fraud Program

Article excerpt

Watch out for Medicare fraud.

That" s the message from the Centers for Medicare & Medicaid Services (CMS) and the federal Department of Health and Human Services Office of the Inspector General (OIG). CMS and OIG are highlighting problems associated with medical identity theft and Medicare fraud as part of a broader effort to reform healthcare.

"When criminals steal from Medicare, they are stealing from ail of us," said HHS secretary Kathleen Sebelius recently in a prepared statement "Thafs why Medicare fraud is one of the Obama administration's top priorities. Preventing medical identity theft is an important part of our work to stop Medicare fraud."

Federal and private-sector estimates of Medicare fraud range from 3 percent to 10 percent of total expenditures, amounting to something between $68 billion and $226 billion annually.

"There has been a lot of activity to vein in fraud and abuse in Medicare," said Marcie Bough, director of federal regulatory affairs for the American Pharmacists Association. "We support these efforts and encourage pharmacists to help make beneficiaries more aware of what they can dotoprevent misuse of their personal information. There is always going to be some rogue activity. Durable medical equipment [DME] seems to be the current hot spot."

Fraud and identity theft are bad for beneficiaries and bad for pharmacy suppliers, said CMS spokesperson Peter Ashkenaz.

"It hits hardest when a legitimate supplier puts in a claim that is denied because that Medicare number has already been used as part of a scam somewhere else. We need to educate providers and beneficiaries that those Medicare and Social Security numbers are as valuable as credit card numbers. Criminal groups have already recognized the value of medical identity."

Law-enforcement officials say that organized crime groups are moving into Medicare fraud in South Florida, Detroit, Southern California, Houston, and other areas. …

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