Here are four things to know:
1. The Obama administration told Congress in June that the administration prevented $42 billion in improper payments to providers in 2013 and 2014 through “big data” detection methods.
2. The Medicare Fraud Strike Force has arrested and prosecuted nearly 1,200 people since 2010 who allegedly participated in defrauding Medicare and Medicaid of more than $3.5 billion.
3. The ACA has a provision requiring anyone who is aware that they have received federal payments that violate federal anti-kickback laws to report that information to authorities within 60 days, or face penalties, prosecution or disbarment from the federal health programs.
4. CMS’ move to pay providers based on quality could make Medicare more vulnerable to “gaming,” said John Washlick, an attorney with Buchanan, Ingersoll & Rooney in Philadelphia. Mr. Washlick told The Fiscal Times, “It seems like a lot of fraud and abuses is really perpetrated through disguised payments from one vendor to another vendor, or from a vendor to a health system provider, or to influence referrals upstream. Those payments, when you’re rewarding referrals upstream and rewarding providers for purchasing goods or services or equipment, that’s kind of all outside the new system of billing of services you are providing to a patient.”
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