Feds turn up the heat on Medicare fraud
June 1, 1998 2 minutes read
Feds turn up the heat on Medicare fraud
Look at the numbers
Chances are good that your hospital is among the three out of every four hospitals facing scrutiny this year from the U.S. Department of Justice's widespread probe into Medicare billing errors.
President Clinton's new budget is turning the screws even tighter now than previously, and there are plans to double the number of health care audits, triple the staffing at the Office of the Inspector General, and pump up to $370 million in new funding into antifraud audits. Govern ment officials hope those efforts will save Medicare more than $2 billion over the next five years.
The U.S. Department of Health and Human Services (DHHS) collected $1.2 billion in total fines, restitution, and settlements last year - six times more than those it collected the year before. Criminal and civil prosecutions totaled 1,340 last year, double the number in 1996 and five times the number in 1995.
More than 2,700 health care providers were excluded from doing business with Medicare, Medicaid, and other federal and state programs for engaging in fraud or abuse activities - an 86% increase over the 1,400 exclusions in 1996. The DHHS has allocated nearly $1 billion dollars through the year 2002 to target health care providers. The agency expects to recover $7 to $11 for every dollar it spends.
The Coalition against Insurance Fraud in Washington, DC, estimates nationwide health care claims fraud in 1995 at $59.1 billion. That estimate breaks down this way: $224.97 per capita, $591.67 per household, and $710.90 per family.
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