The federal government has recovered more than $14.9 billion in fraud over the past three years, thanks in part to whistleblowers. Under the proposed changes, a person who provides information leading to the recovery of money can collect a reward of 15% of the amount recovered, up from 10% under the current rules. If CMS recovers more than $66 million under the proposed change, the reward is capped at $9.9 million.
The proposed changes are modeled on an IRS program that has returned $2 billion in fraud since 2003, HHS said in a media release.
The proposed rule would also strengthen some provider enrollment provisions including allowing HHS to deny enrollment of providers affiliated with an entity that has unpaid Medicare debt, deny or revoke billing privileges for individuals with felony convictions, and revoke privileges for providers and suppliers who abuse billing privileges, HHS said.
The volunteer-based Senior Medicare Patrol program has since 1997 taught more than 3.5 million beneficiaries how to recognize and fight fraud and abuse. More than 7,000 tips have been called in to the Centers for Medicare & Medicaid Services and the Office of the Inspector General.
To expand the SMP program's capacity, the Administration for Community Living issued new funding that makes each of the current 54 SMP projects eligible for rewards from a pot of up to $7.3 million, HHS said.