Congress Discusses Medicare Fraud

March 8, 2011   – Three congressional committees held hearings to discuss health care fraud last Wednesday.  In a report prepared for the House Ways and Means Committee Subcommittee on Oversight, “nearly 10% of all Medicare payments are fraudulent, causing the federal government to lose $48 billion on phony claims and other improper payments in 2010.”

The report, submitted by the Government Accountability Office (GAO), states that this estimate is only for the Medicare fee-for-service and Medicare Advantage Plans, not for the Medicare Part D drug plan or any other government health insurance such as Medicaid. Another estimate was presented by Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association, who estimated that losses from healthcare fraud range from $75 billion to $250 billion annually.  This estimate also included fraud in the private insurance market as well as government programs.

Congressional leaders probed witnesses about what the public and private sectors are doing to combat fraud and how the two sectors can work together in this effort.  Gerald Roy, deputy inspector general for investigations in HHS’ office of the inspector, testified that the inspector general’s strike force efforts across the country have charged more than 800 defendants, of which 390 have been convicted and sentenced, resulting in more than $376 million in court-ordered restitutions, fines and penalties. Together, the inspector general and Justice Department launched the first strike force efforts in 2007. 

Last year’s Patient Protection and Affordable Care Act provides an additional $350 million over 10 years, plus an inflation adjustment, to boost efforts in HHS’ fraud and abuse control program in Medicare and Medicaid.  In addition, President Obama’s fiscal 2012 budget proposal requested a little more than $1.85 billion for this account, which which would be divided among CMS’ programs, the inspector general’s office and the Justice Department.

Tags: Fraud and Abuse, Healthcare Reform