Other anti-fraud accomplishments include hosting a series of regional fraud prevention summits around the country, distributing anti-fraud education to private citizens and increasing the number of cities with anti-fraud Strike Force prosecution teams. In FY 2010, federal prosecutors opened 1,116 criminal healthcare fraud investigations. More than $2.5 billion was recovered through False Claims Act cases alone, the largest in the history of the DOJ.
HHS also announced new rules authorized by the Affordable Care Act, which will help stop healthcare fraud. The final rule includes the following:
• A rigorous screening process for providers and suppliers enrolling in Medicare, Medicaid and CHIP to keep fraudulent providers out of those programs. Certain providers that pose a higher risk of fraud, such as durable medical equipment suppliers, will undergo a more thorough screening process.
• New enrollment process for Medicaid and CHIP providers. States will have to screen providers who order and refer to Medicaid beneficiaries to determine if they have a history of defrauding the government. Providers that have been kicked out of Medicare or another state’s Medicaid or CHIP will be barred from all Medicaid and CHIP programs.
• Temporary halt of enrollment for new providers and suppliers. If a trend indicating healthcare fraud is identified in a category of providers or geographic area, the program can temporarily stop enrollment as long as that will not impact access to care for patients.
• Temporary halt of payment to providers and suppliers suspected of fraud. If there has been a credible fraud allegation, payments can be suspended while an action or investigation is underway.
Read the news release about healthcare fraud.
Read other coverage about anti-fraud measures:
– State Reps. Stark and Herger Will Re-Introduce Medicare Fraud Bill Next Year
