KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Medicare Turns Up Heat On Fraud Investigations

One U.S. attorney in South Dakota says such cases will be one of the fastest-growing areas of criminal investigations, while some providers are crying foul.

Philadelphia Inquirer: Costs Of Expanded Audits Aimed At Medicare Fraud Hit Health Care Firms
In a bid to cut Medicare spending and help pay for health-care changes, the Obama administration has significantly expanded audits designed to recover improper payments from health care providers. "We are taking, I would say, a brutal spanking, those that are fully compliant and within regulation," said Tim Fox, founder and chief executive of Fox Rehabilitation, a Cherry Hill company that provides physical therapy and other services to the elderly. The government has to "recoup those dollars from somewhere, so what they're going to do is fight and recoup dollars in fraud and abuse," said Fox, whose firm employs 905, including 709 clinicians who visit patients in their homes in eight states. The experience at Fox Rehab, founded in 1998, is just one example of how the Affordable Care Act is roiling the industry, forcing providers to find new ways to do things with less (Brubaker, 7/27). 

The Associated Press: U.S. Attorneys Turn Up Heat on Health Care Fraud
The top federal prosecutors from South Dakota and North Dakota say they have increased their efforts to fight health care fraud. U.S. Attorney Brendan Johnson of South Dakota said he has restructured his office to allow lawyers in the criminal and civil divisions to devote "significant time" to investigating medical fraud. He predicted it will be among the fastest-growing area of criminal investigation and wants his office to be in position to pursue increasing "complex and egregious" cases (7/27).

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