Medical Billing Blog

Medicare Bust Sheds Light On Alleged False Medical Billing

Posted by Barry Shatzman on Thu, May, 03, 2012 @ 15:05 PM

Medicare Bust Targets False BillingThis week the government announced a record breaking Medicare fraud bust of the largest scope ever.  107 people were charged in what authorities said was the largest one-day take down ever for Medicare fraudulent billing. A federal health care fraud strike force conducted raids in seven cities yesterday, targeting individuals suspected of passing through more than $450 million in alleged false billing.  Of the 107 people charged May 2, 2012, some were physicians, nurses and other health care professionals and the seven cities included Miami, Tampa, Chicago, Detroit, Houston, Los Angeles and Baton Rouge.

In addition, the government has suspended payments to the 52 provider organizations with which these individuals are associated.  Health and Human Services Secretary Kathleen Sebelius said the operation, including the arrests and the cutoff of payments, is part of an effort to get ahead of fraud instead of relying on the old “pay-and-chase” model.

“Now, we’re analyzing patterns and trends and claims data, instead of just going claim by claim,” Sebelius said. The arrests are the latest in a three-year crackdown on healthcare fraud, which is estimated to cost taxpayers between $80 and $160 billion per year.

While these headline-grabbing take downs usually involve some pretty unscrupulous billing practices, law-abiding physicians and other providers should still take note. It’s inevitable that our government will keep increasing their efforts to identify fraud, billing errors, and inadvertent overpayments. If you are not regularly having your charts and claims audited by an independent auditor or billing service, you should. It’s time to regularly audit claims to ensure compliance with current guidelines. Besides such audits should be part of your practice’s compliance program. 

Keep in mind authorities recovered a record $4.1 billion last year, which is an amazing amount of money. But that still means the government needs to collect $76 to $156 billion more per year in estimated fraud.  In the coming years, most providers will eventually be comforted with audits. Our government has declared war on healthcare fraud in a very big way, and all healthcare workers will need to be part of the solution.  The government push to foster a culture of compliance is here to stay.  It’s best to prevent coming under regulatory scrutiny, and the best way to do that is to institute and enforce a practice compliance program.