[caption id="attachment_4044" align="alignleft" width="222" caption="President Barack Obama"]
[/caption]GHN News - Few people know or understand that under the new health care bill there are components directed towards reducing health care fraud and that so far the biggest roundup of fraudsters has occurred under the Obama administration.
During the last year the Department of Justice has been busy locating offenders, and the new health care legislation provides additional teeth for protecting people against fraud by specific enforcement efforts.
U.S. Department of
Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S.
Associate Attorney General Thomas J. Perrelli today announced a new
report showing that the government’s health care fraud prevention and
enforcement efforts recovered more than $4 billion in taxpayer dollars
in Fiscal Year (FY) 2010. This is the highest annual amount ever
recovered from people who attempted to defraud seniors and taxpayers.
The Affordable
Care Act that will help the department work proactively to prevent and
fight fraud, waste and abuse in Medicare, Medicaid and the Children’s
Health Insurance Program (CHIP).
These statements underline President Obama's interest in eliminating fraud, waste and abuse. He has made this a top priority of his administration according to HHS.
The new directed effort toward fraud protection came about shortly after Obama took office. The Health Care Fraud Prevention & Enforcement
Action Team (HEAT) was created in 2009 to prevent waste, fraud and abuse
in the Medicare and Medicaid programs and to crack down on the fraud
perpetrators who are abusing the system and costing American taxpayers
billions of dollars. These efforts to reduce fraud will continue to
improve with the new tools and resources provided by the Affordable Care
Act, including the new rules announced today.
“President Obama
has made it very clear that fraud and abuse of taxpayers’ dollars are
unacceptable. And for too long, our fraud prevention efforts have
focused on chasing after taxpayer dollars after they have already been
paid out,” said Kathleeen Sebelius of HHS. “Thanks to the President’s leadership and the
new tools provided by the Affordable Care Act, we can focus on stopping
fraud before it happens.”
More
than $4 billion stolen from federal health care programs was recovered
and returned to the Medicare Health Insurance Trust Fund, the Treasury,
and others in FY 2010.
New legislation provides the following:
- Creates a rigorous screening process
for providers and suppliers enrolling Medicare, Medicaid and CHIP to
keep fraudulent providers out of those programs. Types of providers and
suppliers that have been identified in the past as posing a higher risk
of fraud, for example durable medical equipment suppliers, will be
subject to a more thorough screening process. - Requires new enrollment process for Medicaid and CHIP providers.
Under the Affordable Care Act, States will have to screen providers who
order and refer to Medicaid beneficiaries to determine if they have a
history of defrauding government. Providers that have been kicked out
of Medicare or another State’s Medicaid or CHIP will be barred from all
Medicaid and CHIP programs. - Temporarily stops enrollment of new providers and suppliers.
Medicare and state agencies will be on the look out for trends that may
indicate health care fraud – including using advanced predictive
modeling software, such as that used to detect credit card fraud. If a
trend is identified in a category of providers or geographic area, the
program can temporarily stop enrollment as long as that will not impact
access to care for patients. - Temporarily stops payments
to providers and suppliers in cases of suspected fraud. Under the new
rules, if there has been a credible fraud allegation, payments can be
suspended while an action or investigation is underway.
A copy of the regulation is on display today at the Federal Register and may be downloaded from the following link: www.ofr.gov/inspection.aspx.
Several days after the regulation is published, the preceding link
will be deactivated and the published version of the regulation will be
available on the National Archives website at www.archives.gov/federal-register/news.html. CMS will continue to take public comments on limited areas of this final rule for 60 days.
