GAO: CMS Can Do More to Fight Medicare Fraud

The Centers for Medicare and Medicaid Services (CMS) has made progress implementing strategies to combat fraud in Medicare, but the agency can do more according to a new report from the Government Accountability Office (GAO).

In 2011, CMS strengthened provider enrollment by designating three levels of risk with different screening procedures for providers at each level. The agency has failed to complete other provisions of the Patient Protection and Affordable Care Act according to the GAO.

The report states that CMS has not determined which providers will be required to post surety bonds to help ensure that payments made for fraudulent billing can be recovered, contracted for fingerprint-based criminal background checks, or issued a final regulation to require additional provider disclosures of information.

Over the last year, there has been several high profile fraud busts of home health care providers, but there are likely more.

“Although there have been convictions for multimillion dollar schemes that defrauded the Medicare program, the extent of the problem is unknown,” said Kathleen King, Director of Health Care at the GAO during testimony before the Senate Committee on Finance. “There are no reliable estimates of the extent of fraud in the Medicare program or for the health care industry as a whole. By its very nature, fraud is difficult to detect, as those involved are engaged in intentional deception.”

New home health agencies and prospective suppliers of durable medical equipment are considered high risk levels according to the report.

View a copy of the report.

Written by John Yedinak

John Yedinak



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