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

Thursday, December 15, 2011

WASHINGTON - The Obama Administration announced last 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 expand 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.