Medicare and Medicaid Fraud, Abuse Could Exceed Government Figures, Analysts Say
Medicare and Medicaid are being defrauded of far more money each year than the government can track, according to Joseph Antos, a health care scholar at the American Enterprise Institute, CongressDaily reports. Last year, the HHS Office of Inspector General reported that it collected $988 million from health care providers who were accused of making improper claims to Medicare and Medicaid. But according to Antos, total improper claims "have got to be several multiples of $988 million." He said that the "ability to detect improper billing is far less than the ability to do improper billing," adding that the "rhetoric" to improve detection efforts "died down" in the past few years because of federal budget surpluses. However, Antos predicts that "congressional attention will focus once again on fraud and abuse" now that the United States is "back into high and rising deficits." The issue "will never be dead ... as long as you have Medicare paying for each individual service one by one," but "the problem for any administration is that while you'd like to get money back and clamp down on fraudulent billing practices, you don't want to discourage the bulk of honest doctors," Antos said. In a statement, Sen. Larry Craig (R-Idaho), Chair of the Senate Special Committee on Aging, said, "In these tight budgetary times, it is important that every dollar that the federal government spends be well spent for its intended purpose ... But as we go after waste, fraud and abuse within Medicare, we need to make sure that we do not overreact." A spokesperson for House Ways and Means Committee Chair Bill Thomas (R-Calif.), who has in the past urged action against fraud and abuse in Medicare and Medicaid, said Thomas remains "very interested in curbing fraud and abuse in Medicare" (Rich, CongressDaily, 4/20).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.