The U.S. Government has decided to work in concert with state investigators and private insurance companies to target health care fraud. The partnership is intended to greatly increase the collaboration and overall effort to arrest and prosecute individuals and businesses suspected of Medicaid or Medicare fraud. The renewed efforts were no doubt inspired by the overhaul of the health care system by the Obama administration.

Health care fraud has been estimated to represent between 3 and 10 percent of total health care spending in the United States. Despite the relatively small percentage of total costs represented by fraud, the government has greatly increased its efforts to catch and prosecute people for health care fraud. Even low-level participants in fraud plans have come under scrutiny.

Some of the measures take to fight fraud have produced few, if any, results. The software designed to identify potential Medicare fraud and prevent improper payments from being made in the first place cost taxpayers approximately $77 million and had prevented one potentially fraudulent payment several months after its release. Critics of this latest plan point to problems with health care privacy and doctor/client privilege. The White House press release indicated that a “trusted” third party would be responsible for reviewing the data gathered under the program and turning it over to the insurance companies or government investigators.

The FBI and federal prosecutors are serious about punishing people for health care fraud. The complexity of the Medicare and Medicaid billing systems is notorious. Anyone who finds themselves under investigation for health care fraud should speak to an attorney as soon as possible.

Source: Seattle Post Intelligencer, “Gov’t stepping up fight against health care fraud,” by Mark S. Smith and Ricardo Alonzo-Zaldivar, 26 July 2012

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