MEDICARE LAUNCHES ANTI-FRAUD SYSTEM

PhotobucketWASHINGTON D.C. (JULY 13, 2011) – In an effort to prevent billions lost each year in fraudulent Medicare claims, a nationwide computer system for tracking claims was launched in South Florida. The system is designed to examine the millions of daily claims for reimbursement using “predictive modeling,” which can identify suspected hot beds of suspicious activity throughout the country.
To avoid detection, business owners who intend to defraud the Medicare system will often move their business to other areas of the country and begin working the same scam in the new locale. In June, law enforcement charged 21 alleged fraudsters in a $23 million scam; 15 of which were from Michigan, the other six from Florida. Strike force investigators have located Medicare criminal fraud networks extending from Miami to Detroit and Houston to Los Angeles. Since March 2007, strike force investigators have identified that $1.85 billion in fraudulent claims originated in South Florida, which represented the largest portion of the total $2.3 billion nationwide. Officials estimate that Medicare fraud could total as much as $60 billion per year.
In the past, Medicare reimbursements paid first and then examined the claims for discrepancies, which investigators dubbed “pay and chase.” The new system will screen and analyze claims first before payouts are made. If any healthcare providers are found to be submitting suspicious claims, they will first be excluded from participating in the Medicare system and then turned over to law enforcement.