KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Health Care Fraud A Hot Topic On Capitol Hill

Hearings in the House and Senate Wednesday examined public and private efforts to address health care fraud. And the Government Accountability Office issued a new report on fraudulent or improper billing to Medicare.

Politico: GAO: Medicare Losing $48 Billion
Nearly 10 percent of all Medicare payments are fraudulent or otherwise improper, and the government isn't doing enough to stop them. That's the conclusion of a Government Accountability Office report released Wednesday (Coughlin, 3/2).

Modern Healthcare: Panels Scrutinize Anti-Fraud Efforts
Two House oversight committees on Wednesday examined public and private efforts to combat healthcare fraud as the Government Accountability Office reported that Medicare continues to be a "high-risk," fiscally unsustainable government program. Chairing the House Energy and Commerce Subcommittee on Oversight and Investigations, Rep. Cliff Stearns (R-Fla.) cited news reports that Medicare fraud is surpassing the drug trade as Florida's most profitable and efficient criminal enterprise, and he expressed frustration that only estimates-not exact numbers-are available to indicate how much is lost each year to Medicare fraud (Zigmond, 3/2).

The Hill: Swindling Medicare 'Easy,' Fraudster Tells House Panel
Bilking Medicare out of millions of dollars is "incredibly easy," a convicted felon told a House oversight subpanel Wednesday afternoon. Aghaegbuna "Ike" Odelugo, who faces sentencing this spring for Medicare fraud, told lawmakers it didn't take "more than a month" to develop a scheme that swindled Medicare out of nearly $10 million over a three-year period. Odelugo, a Nigerian native who gamed Medicare's durable medical equipment (DME) system, said he only needed basic data-entry skills and a few fraudulent marketers (Millman, 3/2).

PBS Newshour: Medicare Fraud Is 'Incredibly Easy,' Congress Hears 
[A] repentant Odelugo spoke before a congressional subcommittee about how simple it was to commit his crime -- and what Medicare could do to make it more difficult. … The issue has gained new prominence this year, as President Obama and others have emphasized that provisions in the health reform law that aim to curb Medicare fraud are a key money-saving part of the bill (Winerman, 3/2).

Reuters: U.S. Stresses Prevention In Fighting Medicare Fraud
Healthcare programs are moving away from "pay and chase" and concentrating more on prevention in the battle against fraud that costs the government billions of dollars, U.S. officials told Congress on Wednesday. Overseers of Medicare and Medicaid are concentrating on preventing "bad actors" from enrolling as service providers in the massive federal programs that provide healthcare to the elderly and poor, Peter Budetti of the Centers for Medicare and Medicaid Services told the Senate Finance Committee (Smith, 3/2).

The Hill: Hatch Knocks 'Helter-Skelter' Medicaid Fraud Fighting Approach
Sen. Orrin Hatch (R-Utah), the top Republican on the Senate Finance Committee, grilled federal officials Wednesday about their decision to postpone the use of private contractors to recoup fraudulent Medicaid claims. Last year's healthcare reform act extended the use of so-called Recovery Audit Contractors (RACs) to the Medicare Advantage and prescription drug programs. The law also called on states to "fully implement" RAC programs for their Medicaid programs starting April 1, but federal regulators indefinitely postponed that requirement last month (Pecquet, 3/2).

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