Medicare Compliance & Reimbursement
Fraud Fighters Load Up With More Ammo
With numbers like the ones touted by the Taxpayers Against Fraud, the call for increased fraud-fighting resources is likely to get a nod.
In its latest report, "Fighting Medicare Fraud: More Bang For The Federal Buck," the nonprofit organization updates previous studies on the benefit-cost ratio of federal fraud reduction efforts, and with impressive findings. Between 1998 and 2003 alone, the government spent $408 million on investigating, prosecuting and awarding whistleblowers in false claims cases -- and recovered over $5.2 billion in settlements and judgments.
The report's author, health economist Jack Meyer, points out that the deterrent effect of the large settlements won by false claims act prosecutions has changed the way healthcare's corporate culture does business. And with the solvency of the Medicare program hanging in the balance, maintaining and strengthening that effect should be at the top of the government's agenda.
Meyer also says that employees who speak up about wrongdoing remain the lifeblood of the government's prosecution efforts, particularly as provider scams grow more sophisticated and difficult to detect.
"The reason government investigations are so efficient is that whistleblowers act like bird dogs that point out the fraud and flush it to the government attorneys," comments James Moorman, president of the TAF education fund.
"Without the whistleblowers, the federal government just can't find the frauds," he adds.
Lesson Learned: More support and better resources for federal fraud prosecutions could up the ante on compliance issues.
Medicare Compliance & Reimbursement
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