Medicare Compliance & Reimbursement

A move is afoot to up the stakes yet again in the ongoing campaign against health care fraud.

The target: providers who play fast and loose with the Medicaid program.

While the feds collected over $1.3 billion in health-care fraud recoveries in fiscal year 2001, a mere $43 million came from Medicaid cases, according to a new report sponsored by Taxpayers Against Fraud. In other words, collections from fraudulent Medicare providers or contractors were over 20 times the amounts recovered from their Medicaid counterparts, says the report, titled "Reducing Medicaid Fraud: The Potential of the False Claims Act."

This might mean that Medicaid participants are just a lot more honest, but report author Andy Schneider of Medicaid Policy LLC doesn't think so. His analysis concludes that deficiencies in payment oversight, along with state-level legal complications that hinder full use of the federal False Claims Act, have kept recoveries far below what they ought to be.

What may be in store: The report says Congress should amend the False Claims Act to guarantee Medicaid whistleblowers a minimum 20 percent cut of the federal share of any Medicaid recovery. It also suggests the federal government should encourage states to enact their own whistleblower laws by offering to pay states' Medicaid anti-fraud administrative costs.

And a separate report, also sponsored by TAF, suggests that aggressive anti-fraud activities end up more than paying for themselves. According to "Fighting Medicare Fraud: More Bang for the Federal Buck," the feds collected nearly $9 for every dollar spent combating Medicare fraud in 2001.

Lesson Learned: If momentum builds on the issue of Medicaid fraud fighting shortfalls, look for ever more aggressive enforcement at both the state and federal levels.