New measures planned to fight Medicare fraud

MIAMI -- Federal health officials announced new security measures Monday to combat Medicare fraud, including tougher screenings for providers and the ability to withhold payments during investigations.

Authorities recovered $2.5 billion in health care fraud judgments last year -- a record high up 50 percent from 2009 -- according to a new report.

Authorities have long said the solution to solving the nation’s estimated $60 billion to $90 billion a year Medicare fraud problem lies in vigorously screening providers and stopping payment to suspicious ones, ending the antiquated “pay and chase” system authorities say has kept them one step behind criminals.

Health and Human Services Secretary Kathleen Sebelius touted the Affordable Care Act as one of the toughest anti-fraud laws in history.

“The days when you could just hang out a shingle and start billing the government are over,” she said.

Sebelius and Attorney General Eric Holder forged a partnership in 2009 to target fraud hot spots around the country with teams of investigators and prosecutors.

Sebelius said new technology will help authorities view Medicare claims data closer to real time and flag suspicious patterns. More comprehensive background checks, including possibly fingerprinting providers, may also follow.

The agency gets roughly 18,000 applications a month to become Medicare providers. Now it can put a moratorium on new applications in certain areas, like physical therapy, if it notices a spike in fraudulent activities.

The Centers for Medicare and Medicaid Services has come under fire for lax screening as news reports surfaced of criminals with violent records, including a convicted murderer, obtaining Medicare supplier licenses.

Applicants with felony records can only be rejected if their convictions are 10 years old or less.

By the time officials catch on to suspicious billing patterns, crooks typically dump that provider ID and open a new one, or flee the country. Violent criminals and mobsters are also getting involved, seeing Medicare fraud as more lucrative than dealing drugs and having less severe criminal penalties, officials said. The Affordable Care Act will increase the penalties for Medicare fraud.

Scams that once bilked $1 million or $2 million from Medicare a decade ago have also morphed into sophisticated multimillion dollar networks involving doctors, patient recruiters and patients.