Medicare Part D has been in effect for nearly 10 years, but it has accumulated a staggering list of deficiencies when it comes to fraud, waste and abuse. Most notably, the Centers for Medicare & Medicaid Services does not require Part D sponsors to report fraud, making it difficult to determine how much waste exists within the program. In an editorial for Forbes last week, Merrill Matthews, a resident scholar with the Institute for Policy Innovation in Dallas, described how Medicare Part D should be the posterchild for efficiency because of its low improper payment rate. But Matthews fails to acknowledge the pervasive vulnerabilities the Office of Inspector General and others have identified within the Part D program that have made it a target for fraud and abuse.
Medicare Part D pharmacy enrollment, drug reimbursement and durable medical equipment are among the new fraud and abuse focus areas targeted by the Office of Inspector General, according to agency's 2016 Work Plan.
A new federal directive will decrease the amount of hospital claims that Recovery Audit Contractors can review, effectively handcuffing the program's ability to root out improper payments.
After spending the last several months embroiled in national controversy, Planned Parenthood is facing Medicaid fraud allegations that has resulted in an investigation by Texas state officials, according to The Houston Chronicle.
Overhauling the way states recieve Medicaid funding from the federal govnernment could pave the way to improved state-based fraud and abuse prevention, according to one healthcare policy expert.
Kickback schemes run the gamut, from standard cash payments or physician compensation agreements above market value, to stranger bribes that include sporting events and tickets to Justin Bieber or Taylor Swift. These kickbacks often set the stage for multi-million dollar fraud schemes.
Lucrative reimbursement for cardiac procedures in Medicare's fee-for-service model is at the heart of an investigation involving three Indiana surgeons accused of performing unnecessary surgeries on hundreds of patients while the hospital turned a blind eye, according to The New York Times.
The issue of including Social Security numbers of Medicare beneficiary cards has been discussed for more than four decades, including repeated warnings from the Government Accountability Office. Despite those warnings, the Centers for Medicare & Medicaid Services has failed to take even incremental steps to remove the identifying numbers, contributing to pervasive identity theft that exploits seniors and leads to millions in healthcare fraud schemes.
Expert testimony at aSenate Committee on Aging hearing outlined how identity theft can lead to multi-million dollar fraud schemes--and the preventative measures that can protect personal health information.
Scammers commonly referred to as "marketers" are taking advantage of Medicaid beneficiaries throughout Chicago, offering cash kickbacks or free services, while billing for services that were never provided, according to WBEZ Chicago.