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Nov 12, 2009
When the Medicare Part D drug benefit was established in 2006, the legislation contained provisions designed to combat fraud within the program. However, according to a new report from the Office of Inspector General, the government was slow to provide the necessary tools for the sleuths (Medicare antifraud contractors) to adequately do their job.
To discover fraud, the contractors need to analyze beneficiary data for unusual patterns of drug utilization. In several instances, it took the government two to three years to provide contractors with this data — much of which turned out to be riddled with errors. Of the cases of suspected fraud, four in five were the result of tips or complaints rather than data analysis.
4 Responses to “Can Medicare Root Out Fraud? Not If the Past is Any Guide.”
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Helium
November 12th, 2009 at 4:27 pm
Why am I not surprised to learn that the government is no good at rooting out fraud. I believe the teenager on “60 Minutes” said that stealing from Medicare is like taking candy from a baby.
November 12th, 2009 at 4:46 pm
One of the reasons the CBO estimates a public plan option would charge higher premiums than private insurance is because government programs do not engage in utilization management — which includes routing out fraud.
November 12th, 2009 at 7:53 pm
I believe the figure “60 Minutes” used was $60 billion a year in Medicare fraud.
November 13th, 2009 at 9:00 am
That’s like asking: Can the mafia root out criminality? It’s most unlikely.