KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Ways And Means Leaders Advance Fraud Prevention Efforts

The Hill: Leaders of the House Ways and Means Committee have offered a bipartisan bill to allow the Department of Health and Human Services to exclude corporate executives from Medicare if their companies were convicted of fraud. "The bill, introduced by Reps. Pete Stark (D-Calif.) and Wally Herger (R-Calif.), would also give the HHS Office of the Inspector General the ability to exclude parent companies that may be committing fraud through shell companies." The ban would carry over to corporate executives even if a conviction on fraud takes place after the executive leaves the company (Pecquet, 9/15).

California Watch: The inspector general for HHS said in remarks before the House Energy and Commerce Subcommittee on Health Wednesday that a street gang in California managed to fraudulently obtain $11 million in false Medicare payments before its members were caught. "They took advantages of loopholes in Medicare regulations that make it easy to set up a fake medical device company and bill the government for high-ticket items like wheelchairs and oxygen supply systems." Inspector General Daniel Levinson said, "Medicare is basically paying suppliers too much money for some devices, making medical supply an attractive field for fraudsters. For example, he said, it costs about $1,000 for a supplier to buy a wheelchair. However, Medicare reimburses the middlemen $4,000 for the device." It's also easy and widespread for fraudsters to set up empty storefronts to have an address to bilk Medicare (Jewett, 9/16).

KTSP (in St. Paul-Minneapolis, Minn.): In Minnesota, a Medicaid fraud investigation is underway. "The three companies targeted are 'Advantage Home Care Services,' 'America's Choice Nursing' and 'Med-Stat Alliance Home Care.' Two of the companies are connected. Collectively, all three have received millions of taxpayer dollars in Medicaid reimbursements over the past four years. In the search warrants, investigators believe up to half the money might have been obtained fraudulently" (Kolls, 9/15).

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