MANAGED CARE April 1998. ©1998 Stezzi Communications
Flush with successes from recent efforts to sniff out Medicare fraud and abuse, the Department of Health and Human Services has launched the next phase of its antifraud campaign. HHS will begin hiring anti-fraud contractors, following a 60-day public comment period.
Contractors will have liberty to review provider records for medical necessity of claims; cost audit reports, to ensure that only proper overhead was included in claims; and secondary payer determinations, to double-check that Medicare is not paying bills other insurers should cover. The Health Insurance Portability and Accountability Act gives HHS authority to hire the contractors to keep Medicare participants honest.
Using in-house investigators in tandem with law enforcement officials, Medicare saved over $8 billion through anti-fraud and abuse efforts in 1997. HHS estimates that for every $1 it spent on fraud detection activities, $23 was either saved or recovered.