Keeping The System Clean: Fighting Medicare Fraud

By Richard Sorian, Assistant Secretary for Public Affairs. Crosspost from Healthcare.gov

The Department of Health and Human Services (HHS) teamed up with the Department of Justice (DOJ) for the sixth Health Care Fraud Prevention Summit in Philadelphia. This historic moment in Medicare’s fight against fraud illustrates yet another way the health care law, the Affordable Care Act, is making America stronger, safer, and healthier.  In fact this law is one of the toughest anti-fraud laws in American history. Since of the launch of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) task force in 2009, over 670 defendants have been charged for attempting to defraud Medicare of more than $1.3 billion taxpayer dollars.

And we are continuing to use our resources to stop each instance of health care fraud before payments are sent out the door. We have to stay ahead of the criminals and identify their patterns of behavior. Luckily, we are beginning to utilize state-of-the-art analytic technology to predict and identify fraudulent claims in their early stages.

This technology is the same system your bank uses to protect you from potential credit card fraud. From now on, fraudulent Medicare claims will be identified and flagged the same way your card is when the bank sees two exorbitant charges within minutes of each other, 3,000 miles apart. Going forward, a contract between the Centers for Medicare and Medicaid Services (CMS) and Northrop Grumman in partnership with National Government Services and Verizon’s Federal Network Systems officially applies this industry-leading technology to our health care fraud prevention efforts.

So today, we are able to continue to build partnerships between public and private stakeholders, each committed to fight health care fraud. We must all invest in protecting the future of our health care system. The harder we work today, the stronger our system will be for years to come.

As we strive to stop Medicare fraud in its tracks, here are some useful tips for you to stop Medicare fraud in your own home:

  • Guard your Medicare and Social Security numbers. Treat them like you would treat your credit cards.
  • Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. If it’s free, they don’t need your number!
  • Do not let anyone borrow or pay to use your Medicare ID card or your identity. It’s illegal, and it’s not worth it!