Government Joins Forces with Public to Find, Stamp Out Medicare Fraudsters

The home health care industry has seen an enormous amount of Medicare fraud in the past few years, and it may see some more bad apples exposed—and shut down—in upcoming months thanks to a public-private partnership between government and public organizations that’s sending a strong message to would-be fraudsters: We will find you, and we will stamp you out. 

The government is continuing its crackdown on health care fraud—particularly the $60 billion lost each year through fraudulent Medicare claims—and it’s enlisting the public’s help to do so, the Department of Health and Human Services announced on Thursday.

“This partnership puts criminals on notice that we will find them and stop them before they steal health care dollars,” said HHS Secretary Kathleen Sebelius in a statement. “Thanks to this initiative today and the anti-fraud tools that were made available by the health care law, we are working to stamp out these crimes and abuse in our health care system.”

In a ground-breaking move, the federal government, state officials, and several private health insurance organizations along with other healthcare anti-fraud groups are aligning to combat healthcare fraud in a voluntary, collaborative arrangement.

The partnership is designed to share information and best practices among organizations to improve detection and prevent payment of fraudulent healthcare billings. Its goal is to reveal and then halt scams that affect both public and private payers; the partnership will enable those on the front lines of industry anti-fraud efforts to share their insights more easily with investigators, prosecutors, policymakers, and other stakeholders.

In addition, the initiative will help law enforcement officials to more effectively identify and prevent suspicious activities and prosecute illegal actions.

Home health agencies are one of the categories of providers that the government is planning to focus on as an industry that “historically presented concerns.” 

In recent months, home health care industry trade groups have called for an end to the “pay and chase” model of cracking down on fraud, saying it’s better to prevent fraudulent payments from occurring in the first place than to make those payments and then try to recover them. 

They’re not alone in this idea—the Office of the Inspector General (OIG) has also been pressuring the Centers for Medicare & Medicaid Services to impose fraud-prevention sanctions on home health agencies.

The FBI, CMS, and OIG a are few of the federal departments that are partnering with Humana, Blue Cross, Amerigroup, and many other private organizations.

Find out more about the partnership.

Written by Alyssa Gerace

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