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View Diary: Feds charge 91 people in $430 million Medicare fraud scheme (89 comments)

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  •  How Medicare $ is disbursed is changing (2+ / 0-)
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    sethtriggs, ladybug53

    So actually they are trying to prevent unqualified pre payment. Here is a story from NPR a coulple moths ago that talks about fraud fighting

    (Sorry, I don't think my iPod creates an easy hyperlink to the story for all computing devices so you might find the link is funky. If so search for NPR Medicare fraud)

    •  Obamacare computer upgrade requirements - fraud (5+ / 0-)
      But if crooks are smart, it may turn out that computers are smarter. The federal health law and other legislation directed the federal government to start using sophisticated anti-fraud computer systems. Budetti said the systems, which are being used first with Medicare, are similar to those used by credit card companies to detect suspicious purchases.

      "We're able to now verify whether a person was being treated by two different physicians in two different states on the same day or a variety of other possibilities," he said.

      The computer program crawls around the heaps of Medicare claims — some 4 million a day — to look for outliers: spikes in prosthetics in Miami or heart stents in Missoula. And for the first time, doctors and others who want to bill Medicare are being assessed based on their risk to commit fraud. Those who seem crooked are kept out.

      Lou Saccoccio, head of the National Health Care Anti-Fraud Association, said the aggressive computer systems and the government's new authority to suspend payments signal an important change at the Centers for Medicare and Medicaid Services.

      (Noodles' npr link didn't give much information so I thought this quote might show that Obamacare has led directly to additional fraud resources. Fraud prosecutions have a multiplier effect - other fraudsters may conclude that their odds of getting caught have increased and decide to get out of the business.)

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