Viewing entries tagged with 'Fraud'
Fact Check: Fast Facts about Fraud
Posted by The Campaign on January 28, 2010 at 10:14 AM
$60 billion: the estimated amount of fraud within Medicare each year
$17 million: the average annual amount of money saved by each health plan’s anti-fraud operations
$7.60: the average amount of money a health plan returns to the company and policyholders for every one dollar invested in anti-fraud operations – which keeps health care costs down for businesses and working families
Source: Anti-Fraud Management Survey Report for 2007 by the National Health Care Anti-Fraud Association
Health care fraud leads to higher costs for businesses, workers, and families. The overwhelming majority of health claims are legitimate and paid on-time, but for those that might be fraudulent, health plans use a variety of measures to prevent and detect them, including:
· Education and awareness campaigns: Policyholders, providers, and the public are encouraged to report any suspected fraud through telephone hotlines and websites.
· Commitment to safety: Health plans ensure their networks include only credentialed providers to protect consumers from unlicensed providers.
· Cross-disciplinary teamwork: Employees from a variety of backgrounds investigate potential fraud and collaborate across a health plan in order to weed out only potentially fraudulent claims for investigation.
· Communications with policyholders: Policyholders are encouraged to monitor their explanation of benefit forms for medical services they did not receive and to report known instances of health fraud.
· Monitoring and collaboration: Working with external law enforcement agencies at the state and federal levels, health plans prevent and protect consumers from fraud.
· Use of sophisticated software: Analyzing claims data helps predict potential fraud and weed out the “outliers” for further investigation, allowing effective and efficient investigation of the few claims with potential for fraud.
· Commitment to professional excellence: Health plans require credentialing and ongoing annual training for their staff dedicated to investigating health fraud in order to keep up with changes in technology and laws and effectively weed out health fraud and abuse.
FACT CHECK: Government-run Plan and Anti-Fraud Measures
Posted by The Campaign on October 29, 2009 at 9:54 AM
Today, Democrats in the House released the "Affordable Health Care for America Act" which includes a government-run plan. One part of the government-run plan is the inclusion of anti-fraud measures.
A summary of the bill states "Sec. 326. Application of fraud and abuse provisions. Applies Medicare’s anti-fraud and abuse protections to the public health insurance option."
However, today The Wall Street Journal reported on existing fraud in the health care system, particularly within the Medicare and Medicaid programs. The article noted these two programs are "especially susceptible" to fraud. Click here for the full article.
Here are some other facts from the story that make this provision problematic:
"The U.S. loses at least $60 billion to health-care fraud every year, and some estimates put the cost as high as 10% of the nation's total health-care spending, which exceeds $2 trillion.""Medicare, the federal insurance program for the elderly and disabled, and Medicaid, the federal-state program for the poor, are especially susceptible.""The Medicare program, which spends more than $400 billion a year, reviews only 3% of those claims, he said. Medicare has reported that it improperly paid more than $10 billion in claims in the fiscal year that ended Sept. 30, 2008."
MUST READ: Wall Street Journal -- Lawmakers Target Medicare and Medicaid Fraud
Posted by The Campaign on October 28, 2009 at 6:48 PM
The Wall Street Journal reports on the amount of fraud in Medicare and Medicaid and how it could effect the debate around a government-run plan. Here are some key excerpts from the article:
"The U.S. loses at least $60 billion to health-care fraud every year, and some estimates put the cost as high as 10% of the nation's total health-care spending, which exceeds $2 trillion."
"Medicare, the federal insurance program for the elderly and disabled, and Medicaid, the federal-state program for the poor, are especially susceptible."
"Sen. John Cornyn (R., Texas) said government officials still need to figure out why Medicare and Medicaid have a higher rate of fraud than private insurers, especially since Congress is considering creating a public-insurance program."
"Medicare alone...receives 4.4 million claims each day, which have to be paid between 14 and 30 days."
"The Medicare program, which spends more than $400 billion a year, reviews only 3% of those claims, he said. Medicare has reported that it improperly paid more than $10 billion in claims in the fiscal year that ended Sept. 30, 2008."
Click here for the full article.
