Clinton administration launches fraud grants
AoA grants will train retirees to investigate
Federal dollars will begin flowing out into the community in the hopes of recouping even more money by eliminating fraud and abuse from the sprawling Medicare system. The Clinton administration announced in August that it will spend $2.25 million in grants for new programs to complement its ongoing anti-fraud efforts spearheaded by Operation Restore Trust.
Health Care Fraud and Abuse Control Grants totaling more than $1.5 million will cover the costs of audits, inspections, equipment, provider evaluations, investigations, prosecutions, and consumer education, the Health Care Financing Administration (HCFA), which is one of three federal agencies who will administer the grants, announced. The Office of the Inspector General (OIG) of the Department of Health and Human Services (HHS), and the Department of Justice also will administer the grant money.
The Administration on Aging (AoA), an operating division with HHS, also announced $750,000 in grants, which will be distributed to state agencies on aging. This will be added to a $2 million AoA grant announced in June. At that time, HHS Secretary Donna E. Shalala launched a two-year program to recruit and train retired professionals, including accountants, doctors, nurses, investigators, law enforcement personnel, and teachers to volunteer to work with Medicare and Medicaid beneficiaries in identifying fraud, waste, and abuse in those programs.
"It’s really focused on the fact that there are a lot of retired professionals out there who still want to contribute in some wa,y and they have this knowledge that can be used to identify Medicare and Medicaid fraud," says Moya Benoit Thompson, AoA special assistant for legislation and public affairs.
The initiative will spread the grant money across two dozen state agencies on aging, which, in turn, will collaborate with local organizations that work with the elderly. The grant money will cover the costs of recruiting and training volunteers.
Volunteers will work in their own communities and in local senior centers to identify deceptive health care practices such as overbilling, overcharging, and providing unnecessary or inappropriate services, according to the HHS. The retired professionals will be given thorough training on how the Medicare and Medicaid programs work, says Kathy Cubit, director of program management for the Coalition of Advocates for the Rights of the Inform Elderly in Philadelphia, one of the grant recipients.
Rather than fanning out as ad hoc investigators to randomly target hospitals’ medical records, the volunteers will respond to individual complaints. If a Medicare or Medicaid recipient suspects fraud, he or she can contact these volunteers through a local senior center or elder advocacy group. The volunteers will investigate the complaint.
"They’ll be looking a lot at people’s bills situations where people have passed away and are still getting billed for something, Cubit says. "In the case of Medicare, they’ll be looking at situations where someone might be billed for two hours but only saw the doctor for two minutes."
"We’re hopeful we’ll get some [retired] government employees, some [retired] HCFA employees," says LaVerne Naesea, MSW, chief of client services and long-term care for the Maryland Office on Aging in Baltimore, another grant recipient. Naesea is the project’s grants manager for her agency.
AoA has not set a goal for how much it expects to save the federal government, Thompson says. After one year, the program will be evaluated and extended another year if it has proven successful.
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