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Drone assault on Medicare fraud

By Jay MacDonald ·
Tuesday, February 12, 2013
Posted: 10 am ET

This fight rarely makes the headlines. Its ground battles are quiet, even wonky. Its victories are won in mundane federal courtrooms where dark roast and a sturdy pair of bifocals are essential. But don't let the sound of silence fool you: President Barack Obama's administration's war against Medicare and Medicaid insurance fraud is as serious as a drone strike and apparently just as effective.

The government's anti-fraud squad, led by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder, recovered a record $4.2 billion last year and a total $14.9 billion during Obama's first term, more than twice what was recovered the previous four years, according to a joint report released this week.

The feds love acronyms, and this battle unit sports a most appropriate one: the Health Care Fraud Prevention and Enforcement Action Team, which officials are calling "Heat." Indeed, heat is precisely what they're bringing on those who would enrich themselves at taxpayer expense.

What's more impressive than the taxpayer dollars recovered is the work Heat is doing behind the scenes, much of it initiated by health care reform, to not just round up the bad guys but also to board up their points of entry for good.

For years, Medicare and Medicaid fraud thrived for one simple reason: By the time the Centers for Medicare and Medicaid Services smelled a rat, the rat had already been (well-) paid and was likely off to another state, setting up shop under another name and perpetrating fraud all over again.

I know: Hello, it's the 21st century. Sebelius and Holder wasted little time using those newfangled computer machine thingies to detect fraudulent billings quicker (i.e., when the bad guys are still in business), suspend suspicious payments and even freeze accounts altogether. According to the report, in its first year alone, Heat cooked up 536 new investigations.

But it gets better. Thanks to provisions in health care reform, Heat has been able to establish tougher screening of providers and vendors in high-fraud fields such as home health care and medical equipment. The result is that the bad guys are prevented from getting into the system in the first place.

To round up the rats on the run, the feds beefed up communications from program to program so that if a health care provider or vendor gets 86ed from one state's Medicare or Medicaid program, all the Medicare and Medicaid programs nationwide are notified.

Tougher screening. Greater scrutiny. Quicker detection. National blacklisting. Stiffer sentences.

That's how you conduct a drone offensive on Medicare and Medicaid fraud.

Follow me on Twitter: @omnisaurus

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1 Comment
Ray Gotwalt
February 12, 2013 at 12:25 pm

I would like all the Obama haters, especially Republicans to see things like this. Please keep spreading the word about good things such as this.