Monday, June 28, 2010

GAO Issues Report on the Government's Strategy to Prevent Improper Medicare Payments. Will it Work?

On June 15, 2010, the U.S. Government Accountability Office (GAO) released a report identifying five important areas for preventing Medicare fraud, waste and abuse. The strategies in this new report, “Medicare Fraud, Waste, and Abuse: Challenges and Strategies for Preventing Improper Payments,” are: (1) Strengthening the provider enrollment process and standards; (2) Improving the pre-payment review of claims through automated pre-payment claim review; (3) Focusing post-payment claims review on most vulnerable areas; (4) Improving oversight of prescription drug plan sponsors; and (5) Developing a robust process to address resolve vulnerabilities to fraud.

Click here for a link to the 15-page GAO report.

GAO Report (Medicare Fraud)

Does anyone think this will make a difference? Notice the action verbs (improving (2x), strengthening, focusing, developing). The GAO seems pessimistic and notes:

As we reported in March 2010, CMS did not establish an adequate process during its initial recovery audit contracting demonstration or in planning for the national program to ensure prompt resolution of identified improper payment vulnerabilities.

Agency officials indicated that they intended to review vulnerabilities on a case-by-case basis and were considering assigning them to risk categories that would help them prioritize action. However, this recommendation has not been implemented.
The report reveals that CMS processes over 4 million Medicare claims every day with almost no accountability. Health care fraud is out of control. Reading between the lines, the government concedes that the problem is too big to handle. Hence, ithe Government will continue to rely upon insiders to blow the whistle and file qui tam lawsuits using the False Claims Act.

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