Gov't recovered $5.6B in fraudulent payments in 2011

Wednesday, December 14, 2011

WASHINGTON - The Obama Administration announced this week that it recovered 167% more in fraudulent payments this year compared to last year, and it has plans in place to do even better in years to come.

In all, the administration says it recovered $5.6 billion in fraudulent payments in fiscal year 2011, according to a release.

Competitive bidding and the power mobility device (PMD) demonstration project were listed among more than a dozen efforts the administration says will help it continue to fight fraud in the future.

The PMD demo, which will begin in seven "high risk" states on Jan. 1, should guarantee beneficiaries get the services they need while preventing payment when medical necessity is not established, according to the release.

Competitive bidding, which will be expanded to 100 areas by 2013, is intended to be a "stricter requirement" for HME, which has "historically presented a high risk of fraud," according to the release. The program should save $28 billion over the next 10 years, between a $17 billion savings for Medicare and $11 billion in savings for beneficiaries as a result of lower coinsurance and premium payments, according to the release. 

Other fraud efforts as a result of a $350 million investment under the Affordable Care Act: tougher sentences and penalties; better coordination across government; and required compliance programs.




This story is kind of useless. Where was the fraudulent payments recovered from. I know its not HME. Elaborate on your story.

They really misuse the term fraud. If they deny payment over a missing internal date stamp then they consider that a recovery of an overpayment. I am not saying fraud doesn&#39;t exist, but I do believe it is being overstated as part of a scape goating process.<br />
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Since these politicians lack the courage to raise taxes or raise the eligibility age to keep Medicare solvent, they are going to continue demonizing providers. It&#39;s the coward&#39;s way out for these guys. And they aren&#39;t going to stop until their cuts eventually eliminate enough providers to create an access to coverage issue.

I&#39;m appalled reading this propaganda. FRAUD is intentional deception. The vast majority of DME companies that had to pay back money to the government were not intentionally deceiving anyone AND many were victims of an over-aggressive audit. It&#39;s very unfortunate that this administration would release a statement like this and it is even more troublesome to read that "there&#39;s a plan in place to do even better in years to come" - wow. Most DME companies are doing everything they can to try and help patients improve the quality of their life but now the government is misguided in this which hunt and defining clerical errors as FRAUD? Rather than just simplifying the medicare billing process they send out auditors to rip into companies financials searching for any little mistake that they can find so they claim victory and scream fraud. It&#39;s truly disturbing.

Matt, that is exactly what this is about. I have always said this to my friends, you think the government is for you but they are not. Sometimes, it feels like we are just getting ripped off by Medicare. For example, I know someone that provided a power mobility device to a customer. 30 days after the claim was filed he contacted these guys to figure out was going and was informed an ADR letter was sent out but guess what he never received the letter. He asked the representatives what was needed so he could fax it it and he in fact faxed everything and another 30 days went by he contacted them because he didn&#39;t know the status of the claim. He was advised that they did receive and it will take up to 60 days to process it. Now this whole process will take approximately 90 days. He also asked Medicare, what am I supposed to do with future rental months while the claim is in process, she told him to keep sending the future claims in. Now if this guy sends in the claims and they pay them what do you think will happen if the initial claim is denied, they will go back and ask for an overpayment on those future months that were paid. Now tell me who is defrauding who. At the end of the process you would have lost from all angels.

Have any of you been reading and following the Nichole Medical Case in the Federal Court in Philadelphia. If you haven&#39;t I suggest you do. Some of your concerns and questions may be answered in these proceedings. I have left my "E" Mail address since Liz has already placed it in several articles.