Cops Computer Analysts Hunt For Medicare Fraud

first_imgThe Wall Street Journal looks closely at the work of the Medicare Strike Force, which includes FBI agents and CMS workers. Meanwhile, the Government Accountability Office finds Medicare audit contractors may hammer hospitals with multiple reviews of the same payment claims.The Wall Street Journal: How Agents Hunt For Fraud In Trove Of Medicare DataEleven armed FBI agents crept around a stone-and-glass house here just before dawn. An AR-15 rifle and four other guns were registered to the man in the house. … It was no drug lord. The target was a doctor who moonlighted as a movie producer with an Alec Baldwin comedy to his credit. The Justice Department charged the doctor, Robert A. Glazer, with writing prescriptions and certifications resulting in $33 million of fraudulent Medicare claims. The raid in May capped a year-long investigation by the Medicare Fraud Strike Force, a joint effort by the Justice Department and Department of Health and Human Services. Raids that day in six cities resulted in the busts of 90 Medicare providers, including 16 doctors, who were separately charged with generating a total of $260 million of false Medicare billings (Stewart, 8/14).Modern Healthcare: GAO Finds Medicare’s Audit Contractors May Duplicate EffortsThe CMS’ audit contractors may overlap duties and hammer hospitals with multiple reviews of the same payment claims, according to a new Government Accountability Office report that echoes concerns the provider community has voiced for years. The GAO report looked at Medicare’s alphabet soup of auditors: RACs, MACs, CERTs and ZPICs. RACs, or general recovery auditor contractors, are the most well-known and have been in place since October 2009. They review hospital claims for inappropriate payment after Medicare has already paid. Four companies—Performant Recovery, CGI Federal, Connolly and HealthDataInsights—serve as the Medicare RACs (Herman, 8/14). This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Cops, Computer Analysts Hunt For Medicare Fraudlast_img

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