Fraud Prevention Efforts Recoup Over $3.3 Billion for Medicare

Great news! The Obama Administration announced on Thursday the recovery of over $3.3 billion in fraudulent health care payments for fiscal year 2014. This amounts to a return of $7.70 for every $1 invested in fraud prevention, detection and investigation efforts in the last 3 years. It also marks the 3rd highest return on investment since fraud prevention efforts began over 2 decades ago, according to a report released by the Department of Health and Human Services and the Department of Justice.

These kinds of results show that our fraud prevention and detection efforts are paying off. As the Administration has shorten investigation to arrest times and moved away from a pay and chase model, the results have improved dramatically. For example, the government now uses predictive analysis technology to quickly identify fraudulent or suspicious billing patterns. This led to 469 investigations in fiscal 2013 which identified or prevented $211 million in improper payments — nearly double the amount in the first year of the system a year before.

In 2014, the Administration also gave the Centers for Medicare and Medicaid Services the authority to screen providers, remove doctors and other providers with a history of abusive billing patterns. Since that change, CMS has stopped billing privileges for 470,000 and revoked privileges for nearly 28,000 others.

Medicare estimates it loses about 10% of the money it puts out to fraud each year. As Medicare spent $583 billion in 2013, that’s over $58 billion lost to fraud. While the gains in fraud detection and prevention are great, we have more work to do, and our Senior Medicare Patrol with over 600 volunteers statewide are doing a great job!

Help us grow these good results and prevent fraud by:

  • Guarding your Medicare card and number, just like you would your credit card.
  • Check your Medicare Summary Notices for any services or items you never received.
  • Beware of people offering “free” services in exchange for your Medicare number. They are not free; that is a red flag. They most likely are charging Medicare large amounts for a service or item you don’t require or may never receive.
  • Do not give your Medicare number or Social Security number over the phone to people who say they are from Medicare or SSA. Medicare and SSA already have your information. They will not call you by phone.

If you suspect fraud, contact your local Health Insurance Counseling and Advocacy Program (HICAP) at 1-800-434-0222 or our Senior Medicare Patrol at 1-855-613-7080. See our Fraud section for more info on Medicare fraud.