Both CHA and our Senior Medicare Patrol (SMP) project are highlighted in TIME Magazine’s article, Washington Ratchets Up the Fight Against Medicare Fraud. It discusses what Medicare fraud is and the problems in fighting it.
While there is no official figure in how much fraud costs the government each year, the National Health Care Anti-Fraud Association estimates that about $60 billion government dollars are lost to fraud annually, close to 10% of what Medicare and Medicaid spend on an annual basis.
The system has long assumed that all providers are honest, automatically paying out claims without a strong fraud detection screening process. This has created an easy target for scam artists as Medicare processes about 4 million claims a day, paying close to $1 billion. Medicare has been using the “pay and chase” model, only finding out about fraudulent claims after they’ve long been paid and then “chasing” the offender(s) to recover the funds. Health care reform is changing this and Medicare is investigating automatic fraud screening systems to detect suspicious billing patterns and potential fraudulent billers before claims are paid. (Read more about new tools to prevent and fight fraud).
This TIME article also emphasizes the key role seniors, educated by their local SMP programs, play in fraud detection and prevention.