Medicare’s investment in a new and improved fraud police is worth it, according to the program chief, who says the federal government won back $23 for every $1 spent on the fraud detection pilot project in two years.
"Operation Restore Trust," the five-state anti-fraud initiative launched by Medicare in May 1995, recouped close to $188 million, according to Department of Health and Human Services Secretary Donna Shalala.
Shalala cites these additional achievements in five years: 74 criminal convictions, 58 civil actions, 218 fraudulent providers excluded from Medicare and Medicaid, and 210 cases still under investigation.
Because of its success, HHS will immediately expand the project to the following 12 states: Arizona, Colorado, Georgia, Louisiana, Massachusetts, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee, Virginia, and Washington.
President Clinton is increasing the anti-fraud budget from $452 million to $599 million over the next five years, HHS officials said in a prepared statement.
Here are tools federal officials are using to improve their fraud-detection efforts, Shalala said in a prepared statement for the press:
• sophisticated statistical methods to identify providers for investigations and audits;
• expanded fraud hotline [(800) HHS-TIPS];
• interdisciplinary teams to review individual facilities with unusually high Medicare reimbursement rates;
• increased emphasis on concerted planning and conducting of investigations with the Department of Justice and other law enforcement agencies;
• training and empowering state and local organizations and ombudsmen to detect and report fraud in nursing homes and other settings;
• use of state survey officials who regularly monitor care in home health agencies and nursing homes to help identify inappropriate and fraudulent billing.
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