Email  Print

Healthcare fraud hurts us all

Valley Forum

While people talk a lot about the rising cost of healthcare, every year criminals steal billions of dollars from Medicare, Medicaid and the Children's Health Insurance Program (CHIP). This is taxpayer money that should be going to medical treatment for some of our most vulnerable citizens.

Fraud hurts everyone by driving up healthcare costs and undermining the financial sustainability of federal healthcare programs.

What's the federal government doing to stop it? Plenty. For one thing, we're becoming more proactive about keeping criminals out of federal healthcare programs in the first place. My agency, the Centers for Medicare & Medicaid Services (CMS), has adopted a more rigorous screening process for new providers and suppliers. This is intended to weed out crooks before they can submit fraudulent bills.

Under the Affordable Care Act, we can now use sophisticated new technologies and innovative data sources to identify patterns associated with fraud. When there's a credible allegation of fraud against a provider or supplier, we can temporarily stop payments to them while an investigation is undertaken.

In other words, CMS is moving away from the old "pay and chase" model of doing business - paying out claims and then trying to recover the fraudulent ones.

Of course, we know that most providers are honest. But we're becoming more vigilant about the dishonest few. And those who defraud federal healthcare programs will face tougher penalties.

The Affordable Care Act increases federal sentencing guidelines related to healthcare fraud involving $1 million or more in losses to federal programs. And crooks kicked out of one state's Medicaid or CHIP program will now be kicked out of all states' Medicaid or CHIP programs.

Is Medicare making progress in the fight against fraud? Yes, we are. For example, the federal government recovered $4 billion last year from people who attempted to defraud seniors and taxpayers. That's a record amount.

How can individuals help fight healthcare fraud?

If you have Medicare, here are some things you can do:

• Guard your Medicare and Social Security numbers. Criminals use these numbers to send the government bogus medical bills - in your name.

• Hang up if someone calls and asks for your Medicare number, Social Security number, or bank or credit card information. Medicare will never call and ask for this information.

• Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number.

• Don't let anyone borrow or pay you to use your Medicare ID card or your identity.

• If your Medicare Summary Notice shows billings for goods or services that you never received, call us at 800-633-4227. The sooner you see and report suspected fraud, the sooner we can stop it.

David Sayen is Medicare's regional administrator for California.