Even in the midst of one of the most divisive and highly partisan periods in recent U.S. political history, antagonists can agree on a few topics. One point of agreement is that Medicare fraud – between $60 billion and $90 billion a year – endangers the program’s fiscal stability, the physical health of participants and, in the long run, the economic health of the nation. Most attempts to reduce Medicare cheating have proved ineffective. Now, new rules – embodied in the unfairly reviled Affordable Care Act – provide tools that should help combat the massive fraud.
Authorities generally agree that the best way to combat Medicare fraud is to carefully vet providers and to institute a system that flags, then slows or stops payments to those who are suspicious. Unfortunately, the old regulations and tracking systems available weren’t up to the job. There’s reason to believe new rules and technology will be far more effective.
Health and Human Services Secretary Kathleen Sebelius believes so. She says that the Affordable Care Act strengthens the hand of those enforcing the law. “The days when you could just hang out a shingle and start billing the government [for Medicare services] are over.” Those are brave words that must be backed by action that reduces fraud.
There are several reasons to believe Sebelius’ statement is more fact than wishful thinking. Some positive steps in reducing fraud already have been taken. A partnership coordinated by Sebelius and U.S. Attorney General Eric Holder has produced teams of investigators and prosecutors that travel the country finding and prosecuting fraud. The joint program has produced undeniable results.
Last year, authorities report they collected $4 billion in health care fraud judgments. The total includes defrauded money from previous years collected in 2010, but the amount is still impressive by any measure. The total is likely to increase this year and in subsequent years.