Medicare Fraud Recovery Totaled $4B in 2010

Cheryl Clark, for HealthLeaders Media , January 25, 2011

Medicare Fraud Strike Force Teams have expanded since 2009, which aided in the recovery, the statement said.

The funds recovered include $590 million, which resulted from 140 indictments involving charges against 284 defendants who collectively billed the Medicare program improperly or inappropriately.

Also, the government obtained 217 negotiated guilty pleas, litigated 19 jury trials and won guilty verdicts against 23 defendants.

During the fiscal year, 146 defendants were imprisoned, with incarceration sentences averaging more than 40 months.

Specifically, the new rules promulgated by the legislation will allow Medicare, Medicaid and the Children's Health Insurance Program to screen providers who classified in a group that has a higher risk of fraud, such as durable medical equipment suppliers.

Providers also have tougher screening requirements, and barred from participation if they have ever been kicked out of any state program.

Modeling software may now be used to identify trends that may point to fraudulent practices, similar to models that look for credit card fraud.

Rather than attempt to recover money after it has been found to be fraudulently reimbursed for invalid claims, the new law allows the government to temporarily stop payments when their practices are suspected of being fraudulent. "Under the new rules, if there has been a credible fraud allegation, payments can be suspended while an action or investigation is underway."

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.

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