Feds turn up the heat on Medicare fraud
May 1, 1998 less than 1 minute read
Feds turn up the heat on Medicare fraud
Look at the numbers
Chances are that your hospital is one of 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. The president's new budget is turning the screws even tighter 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 new funding into antifraud audits. The efforts are hoped to save Medicare more than $2 billion over the next five years.
The Department of Health and Human Services (DHHS) collected $1.2 billion in total fines, restitution, and settlements last year - six times higher than those of the year before. Criminal and civil prosecutions totaled 1,340 last year, double the number for 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 - an 86% increase over the 1,400 exclusions in 1996. The DHHS has allocated upward of a billion dollars through year 2002 to target 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 figure breaks down into $224.97 per capita, $591.67 per household, and $710.90 per family.
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