Medicare fraud/abuse: Focus shifts to providers
Not-so-obvious coding errors and self-referral practices are a growing target for the government and contractors, health care attorneys say.
National Report-In the eyes of Medicare, there’s obvious health care fraud and abuse-cases where physicians claim they provided services that never happen or purposely up-code, reaping millions in government reimbursement. But that is only part of health care fraud and abuse. Not-so-obvious coding errors and self-referral practices are a growing target for the government and contractors, health care attorneys say.
Ms. Laemmle-Weidenfeld“There has been an increase in at least the last 10 years in health care fraud enforcement, and I don’t see that reversing anytime soon. What we’re seeing a lot of right now is not just a focus on the really big hitters, like the pharma companies, device companies, and hospital systems. We’re seeing more focus on physician practice groups. We’re seeing a lot more focus on individual accountability, versus just corporate accountability,” said Laura F. Laemmle-Weidenfeld, Esq, partner at the Jones Day law firm in Washington.
In fact, recent legislation is helping to fuel the focus on fraud and abuse. H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, which most notably repealed the dreaded sustainable growth rate formula, became law on April 16, 2015. In addition, the House version of the bill carries language aimed at ramping up Medicare’s ability to fight fraud. According to section 7 of the bill, for example, the Secretary of Health and Human Services will develop a plan to revise the incentive program that encourages increased participation by individuals to report Medicare fraud and abuse. Among the recommendations in the new plan will be ways to enhance rewards for those reporting fraud and abuse, as well as extending incentives to Medicaid.
A public awareness and education campaign will include recommendations for the use of the Senior Medicare Patrols, which are part of the Older Americans Act of 1965, to further encourage participation in the revised incentive program.
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