Affordable Care Act Linked To Increased Recovery Of Fraudulent Medicare Payments

Under the Affordable Care Act, all providers had to go through a reapplication process in order to participate in Medicare.  Those who didn’t meet certain requirements, had felony convictions, incorrect addresses or didn’t have the proper licenses were removed from participation in the Medicare program.  While 6,307 providers and suppliers had their Medicare billing privileges revoked during the two year period before the new system went into place, privileges have been removed from 14,663 providers and suppliers in the last two years.  Moreover, within the last four years, the government has recovered $14.9 billion in fraudulent Medicare payments.

The government is hoping to increase these figures by encouraging beneficiaries to report suspected fraud through a proposed rule which would increase the money that a whistle blower can receive.  Under the current system, the most that an individual whose tip leads to the recovery of fraudulent payments can receive is $10,000.  If the new rule is adopted, this figure would increase to a maximum of $9.9 million.  To assist in detecting when fraud might be taking place, beneficiaries are now being provided with a simplified statement which allows them to see exactly who has been using their identification number to submit bills to Medicare.  This has resulted in seniors contacting Medicare’s fraud hotline over the past year to report billing by doctors who they had never seen.  One provider was the source of calls from 200 to 300 Medicare beneficiaries.  This system is also being used to identify and track providers who are fraudulently using Medicare beneficiary numbers. 

Kathleen Sebelius reported last week that the reduction in fraudulent payments will result in Medicare remaining solvent for two more years than had been previously estimated.