Federal Government Fraud Recovery Rates Differ for Medicare, Medicaid, Studies Find
The federal government recovers 20 times more money from prosecuting Medicare fraud cases than from prosecuting Medicaid fraud cases, according to two studies released yesterday by the Taxpayers Against Fraud, the AP/Las Vegas Sun reports (Jakes Jordan, AP/Las Vegas Sun, 6/3). The studies found that in 2001, the federal government recovered more than $1 billion from Medicare fraud prosecution, compared with $43 million from Medicaid fraud prosecution. The recovery rate trend has been consistent over the last five years, the Hartford Courant reports (MacDonald, Hartford Courant, 6/4). The fraud recovery discrepancies between Medicare and Medicaid appear to be associated with the fact that 39 states have not adopted a local version of the federal False Claims Act, which gives prosecutors broad power to combat fraud and protects whistleblowers who report Medicare and Medicaid fraud, the AP/Sun reports. Although the False Claims Act cannot be applied to the states' share of Medicaid fraud because it is a federal law, states initiate investigations for the crime.
"Where there is fraud in the health care system, it tends to be pretty sophisticated," Andy Schneider, author of one of the studies and a health care consultant, said, adding that such fraud is "very hard ... to detect without a whistleblower" (AP/Las Vegas Sun, 6/3). James Sheehan, assistant U.S. attorney in Philadelphia, said, "The level of fraud is probably about the same in the two programs" (Hartford Courant, 6/4). Sheehan added that the False Claims Act is crucial to recovery in Medicare fraud, saying: "How do we get all these cases? Whistleblowers" (AP/Las Vegas Sun, 6/3). "The good news is that fraud recoveries are saving the taxpayers billions of Medicare dollars. The bad news is that we're not doing as well on Medicaid fraud. We need to fight Medicaid fraud more effectively," James Moorman, president of the Taxpayers Against Fraud, said. Gregory Demske, who oversees civil fraud enforcement for the HHS Office of Inspector General, said, "There's much more to be done on the Medicaid side" (Hartford Courant, 6/4). The first study is available online. The second study also is available online. Note: You must have Adobe Acrobat Reader to view the studies.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.