With help from the Affordable Care Act, government fraud investigators will make more use of computer programs to detect Medicare and Medicaid scams.
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With help from the Affordable Care Act, government fraud investigators will make more use of computer programs to detect Medicare and Medicaid scams.
Fighting health care fraud in the U.S. can seem like an endless game of whack-a-mole. When government fraud squads crack down on one scheme, another pops up close by.But the fraud squads that look for scams in the federal Medicare and Medicaid programs have some new weapons: tools and funding provided by the Affordable Care Act.Medicare and Medicaid pay out some $750 billion dollars each year to more than 1.5 million doctors, hospitals and medical suppliers. By many estimates, about $65 billion dollars a year is lost to fraud.For a long time we were not in a position to keep up with the really sophisticated criminals," said Peter Budetti, who oversees anti-fraud efforts at the Centers for Medicare and Medicaid Services. "They're not only smart, they're extremely well-funded. And this is their full-time job."
And their creativity is endless. Criminals use real patient IDs to bill for wheelchairs that were never delivered or exams never performed. Dishonest doctors — a small percentage of physicians, to be sure — charge for care they never deliver or perform unnecessary operations. In one scam, criminals bill Medicare and a private insurer for the same patient.
and who are the primary billers? those old buddies of the republican party insurance companies, now there is a clearer reason that the right fights so hard for them and not "we the people", we are seen by them as the catalyst to the billions, remember the big bucks are in the treatment not the cure.
But if crooks are smart, it may turn out that computers are smarter. The federal health law and other legislation directed the federal government to start using sophisticated anti-fraud computer systems. Budetti said the systems, which are being used first with Medicare, are similar to those used by credit card companies to detect suspicious purchases.
"We're able to now verify whether a person was being treated by two different physicians in two different states on the same day or a variety of other possibilities," he said.
this technology has been around awhile, what took so long?
