$1B Medicare Fraud

[GoPokes]

Vice President of Health Care Software and Services Company Pleads Guilty to $1B Health Care Fraud Conspiracy

Is this a new record? I suppose it's all baked into the new medsupp rate increases. Too bad Medicare can't identify and stop these sort of things sooner. Too bad there isn't any way to audit Medicare claims, and create a better checks and balances.

 

[somarco]

This past April, (2024) in a report by the Government Accountability Office (GAO), concerns were raised about payment errors in Medicare and Medicaid. Known as "improper payments," these are payments that are either made in an incorrect amount or should not have been made at all.

The GAO estimated that the Department of Health and Human Services had a combined total of over $100 billion in improper payments in fiscal year 2023, representing 43% of all improper payments across all federal agencies. At that time, the GAO stressed the need for the federal government to strengthen its efforts to prevent these improper payments, which could include billing errors, fraud and/or overpayments.

What You Need to Know About Elon Musk's DOGE's Access to Medicare Systems

Officials at Musk-led DOGE were given access to agency data systems and technology at the Centers for Medicare and Medicaid Services (CMS), an agency with a $2 trillion budget.

www.kiplinger.com

So much money floating around up there and no one has a clue where it goes.

 

[straightnochaser]

I think Senator Rick Scott has that beat

 

[annon123]

This past April, (2024) in a report by the Government Accountability Office (GAO), concerns were raised about payment errors in Medicare and Medicaid. Known as "improper payments," these are payments that are either made in an incorrect amount or should not have been made at all.

The GAO estimated that the Department of Health and Human Services had a combined total of over $100 billion in improper payments in fiscal year 2023, representing 43% of all improper payments across all federal agencies. At that time, the GAO stressed the need for the federal government to strengthen its efforts to prevent these improper payments, which could include billing errors, fraud and/or overpayments.

What You Need to Know About Elon Musk's DOGE's Access to Medicare Systems

Officials at Musk-led DOGE were given access to agency data systems and technology at the Centers for Medicare and Medicaid Services (CMS), an agency with a $2 trillion budget.

www.kiplinger.com

So much money floating around up there and no one has a clue where it goes.

Are they including upcoding in the improper payments? That's a huge issue. There is a local ER that is outsourced to a for profit and the staff have a "mandate" that they have at least $1200 in billable charges for each patient that comes through the door (even if they don't need it). Then they can upcode the physician time involved.

 

[Fisher]

"The DME suppliers and pharmacies that paid illegal kickbacks in exchange for these doctors' orders generated through DMERx billed Medicare and other insurers more than $1 billion."

I'm curious what the fallout is for the vendors and pharmacies that were buying these illegitimate scripts.