Medicare Update

Top Ten Medicare Update Blog Posts in October 2009

Below are the top ten Medicare Update posts during October 2009 (based on the number of views):

1)   CMS Announces 2010 Medicare Premiums and Deductibles

2)   OIG Work Plan Reveals Possible Risk Areas for Medicare Providers and Suppliers

3)   Senator Stabenow Introduces Medicare Physician Fairness Act of 2009

4)   OIG Work Plan Identifies Possible Areas of Concern for Home Health Agencies and DMEPOS Suppliers

5)   CMS Directs Medicare Contractors to Take Action on OIG Reports

6)   CMS Posts FAQ on Code 432 and Medicare Recovery Audit Contractors

7)   The Changing Dynamics of Medicare Fraud Schemes?

8)   Medicare Fraud and Recovery Audit Contractor Program

9)   CMS to Shelve Medicare Medical Home Demonstration

10) Region D Recovery Audit Contractor Updates CMS Approved Audit Issues

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60 Minutes to Explore Medicare Fraud in Upcoming Episode

The television show 60 Minutes will be exploring Medicare fraud this Sunday, October 25, 2009 at 7:00 p.m. ET/PT.  According to a recent CBS News article, Medicare fraud may be costing U.S. taxpayers as much as $60 billion per year.  A preview of the upcoming 60 Minutes episode is below.

Watch CBS News Videos Online

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HHS Releases 2008 Health Care Fraud and Abuse Control Program Report

The Department of Health and Human Services (HHS) and Department of Justice (DOJ) recently released the Health Care Fraud and Abuse Control Program Annual Report for FY 2008 (Annual Report).

According to the Annual Report, the Federal government won or negotiated approximately $1 billion in judgments and settlements, and attained additional administrative impositions in health care fraud cases and proceedings during fiscal year (FY) 2008. During FY 2008, the Medicare Trust Fund also received transfers of approximately $1.94 billion as a result of these efforts (and those of preceding years). 

The Annual Report also indicates that during FY 2008:

• U.S. Attorneys' Offices opened 957 new criminal health care fraud investigations involving 1,641 potential defendants;
• Federal prosecutors had 1,600 health care fraud criminal investigations pending involving 2,580 potential defendants and filed criminal charges in 502 cases involving 797 defendants;
• A total of 588 defendants were convicted for health care fraud related crimes; and
• DOJ opened 843 new civil health care fraud investigations and had 1,311 civil health care fraud matters pending.

The Health Insurance Portability and Accountability Act of 1996 established the Health Care Fraud and Abuse Control Program (HCFAC).  Under the joint direction of the Attorney General and HHS (acting through HHS' Office of Inspector General), the HCFAC program is designed to coordinate Federal, State and local law enforcement activities concerning health care fraud and abuse. 

Since its inception, the HCFAC has returned over $13.1 billion to the Medicare Trust Fund.

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Medicare Fraud Strike Force Remains Active in Los Angeles

A number of new organizations (including a Reuters article) have reported that 18 individuals in the Los Angeles, California area have been recently indicted on various charges related to alleged Medicare fraud schemes involving approximately $25 million in fraudulent billings for durable medical equipment.

The Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques. The Strike Force efforts in Los Angeles are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), which is a joint Department of Justice and Department of Health and Human Services effort to reduce and prevent Medicare fraud. 

Since its inception in March 2007, the Medicare Strike Force has reportedly resulted in indictments of 331 individuals who collectively billed the Medicare program for more than $720 million.

See the Reuters article for more details regarding the recent indictments.

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Related Posts:

• DOJ and HHS Announce New Interagency Health Care Fraud Prevention and Enforcement Action Team
• Medicare Fraud Strike Force Operations Continue in Houston, Texas

HHS to Webcast Medical Identity Theft and Medicare Fraud Event

The Department of Health and Human Services (HHS) will webcast a Preventing Medical Identity Theft and Medicare Fraud event on Thursday, October 15 at 1:30 p.m. (EDT). The webcast can be accessed here.

HHS also recently released a Medical Identity Theft & Medicare Fraud brochure for beneficiaries, which highlights some tips for deterring, detecting and defending against medical identity theft and Medicare fraud.

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The Changing Dynamics of Medicare Fraud Schemes?

In a recent Associated Press article, Kelli Kennedy reports on the apparent changing dynamics of Medicare fraud schemes.

According the article, organized crime and violent criminals have an increasing presence in Medicare fraud schemes. In fact, the article suggests that such individuals and/or organizations have been attracted to Medicare because health care fraud is not as dangerous as other forms of crime, is more lucrative, and provides for shorter prison sentences than various other forms of crimes.

The article also points out the possible increasing violence associated with health care fraud schemes. The Associated Press article can be found here.

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Michael Apolskis Quoted on Medicare Recovery Audit Contractors in Orthopaedic Practice Management

In the September 2009 issue of Orthopaedic Practice Management, Michael Apolskis comments on the Medicare Recovery Audit Contractors Program, Medicaid Integrity Contractors, and the Health Care Fraud Prevention and Enforcement Action Team (or HEAT).  The articles can be accessed here.

The articles are being used with permission from Orthopaedic Practice Management, published by Oakstone Medical Publishing. To subscribe to the full newsletter call 800-633-4743 or log onto www.cmeonly.com!

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Medicare Fraud Strike Force Operations Continue in Houston, Texas

On July 29, 2009, the Department of Justice (DOJ) announced that 32 individuals have been indicted for alleged schemes to submit more than $16 million in false Medicare claims.

According to a DOJ Press Release, the indictments were returned by a grand jury in Houston and included arrests today in Houston, New York, Boston and Louisiana.  Medicare Fraud Strike Force (Strike Force) members also executed 12 search warrants at health care businesses and homes in the Houston area.

The DOJ reports that the 32 individuals are accused of various Medicare fraud offenses and that the alleged schemes involved billing for "arthritis kits," power wheelchairs and enteral feeding supplies.  According to the Press Release, the DOJ alleges that the schemes involved billing for medically unnecessary items, which in some cases were never provided.  In other cases, the DOJ alleges that Medicare beneficiaries were deceased at the time they allegedly received the items.

The Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques. The Strike Force efforts in Houston are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), which is a joint DOJ and Department of Health and Human Services effort to reduce and prevent Medicare fraud. 

Since the Strike Force's inception, the Strike Force has obtained indictments of more than 293 individuals and organizations that collectively billed Medicare more than $674 million.  Houston is part of the fourth phase of Strike Force operations. The first phase began in South Florida in March 2007, which was followed by a second phase in Los Angeles in May 2008 and a third phase in Detroit in March 2009. 

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Related Posts:

• Medicare Fraud Strike Force Operations Lead to Charges Against 53 Individuals
• DOJ and HHS Announce New Interagency Health Fraud Prevention and Enforcement Action Team  

Health Affairs Publishes CMS Roundtable Discussion

On July 22, 2009, the Health Affair Blog published a roundtable discussion involving former Administrators and senior officials of the Centers for Medicare & Medicaid Services (CMS), which was formerly known as the Health Care Financing Administration.  The roundtable discussion addresses issues such as Medicare fraud, CMS contracting, CMS's role, and physician compensation. The roundtable discussion can be found here.

UPDATE: House Democrats Introduce America's Affordable Health Choices Act

Yesterday, a number of news organizations (including a Wall Street Journal article) reported that House Democrats would introduce health care reform legislation on July 14, 2009.  The legislation was introduced later that day and it is entitled America's Health Choices Act of 2009 (H.R. 3200).

In addition to addressing private health insurance reforms (and a public health insurance option), H.R. 3200 would make a number of changes to the Medicare program. In fact, as introduced, the changes to Medicare's Part A and B fee-for-service (FFS) program appear to be significant. Some of the highlights (as reflected in the House Ways and Means section-by-section analysis) are briefly outlined below.