Lawmakers Crack Down on Medicare / Medicaid Fraud to Help Fund Health Care

Posted in Health Insurance , Medicaid , Medicare

November 2nd, 2009

Senate members are in a mad scramble for cash to finance the health care overhaul, leaving them to look the money they lose every year to Medicare and Medicaid fraud. According to Senate Judiciary Committee Chairman, Patrick Leahy (D-Vt.), cracking down on this type of fraud could help reduce the skyrocketing cost of health care.

Antifraud Efforts in Health Care Legislation

The new health-overhaul legislation that’s moving through Congress has provisions in it to help reduce fraud. The U.S. government is said to lose between $60 billion and $2 trillion to health-care fraud every year. Medicare and Medicaid programs are especially susceptible.

Why So Much Fraud?

U.S. officials are having a difficult time determining why fraud is so high with these two programs; however, they suspect it may have something to do with the guidelines for filing a claim. For each file claimed, payment has to be made in 14 to 30 days. With Medicare only receiving upwards of 4.4 million claims each day, only 3 percent are reviewed. As a result, more than $10 billion was improperly paid in claims in the fiscal year ending Sept. 30, 2008.

Officials note that cracking down on fraud now is especially important, not just to fund the health overhaul, but to also set the right standard for the public-insurance program lawmakers are pushing for. Being able to slow down fraud could add millions to the health overhaul and possibly reduce responsibility additional to taxpayers substantially.