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Congress Cracking down on Medicare Fraud

Capitol News Connection

Even as Congress prepares to slash most government programs, one is slated to grow. The federal government is spending more than ever to combat Medicare and other medical fraud.

Health care fraud costs the federal government at least seventy-billion each year. Last year, Colorado Springs-based Spectranetics agreed to pay five million to settle allegations it defrauded Medicare – smuggling in unapproved medical devices and providing them to doctors to use on patients. Charles Hackney is a special agent with the Department of Health and Human Services in Kansas City, Missouri. He oversees four agents in Denver who prosecute medical fraud in Colorado.

HACKNEY: “In one case just recently closed there was a provider of surgical services who was upcoding and billing for services not rendered.”

“Upcoding” refers to billing for a more expensive procedure than was actually performed. The surgical services provider in question was also in Colorado Springs. This summer, Denver-based Alpha Sleep Diagnostic Centers were accused of using unlicensed sleep technologists to treat patients.

Shortly after President Obama took office, the administration set up a Health Care Fraud Prevention and Enforcement Team, known as HEAT, to pair the FBI with agents like Hackney. The special agent says criminals are finding new ways to target Colorado seniors.

HACKNEY: “And those types of crimes are the kind in which telemarketers will call Medicare beneficiaries and ask for personal information…which in turn will be used to submit fraudulent claims to Medicare.”

While most federal programs will shrink under a recent budget deal Congress approved to avoid a government default, money to combat health care fraud will nearly double next year

That’s largely because every dollar spent on enforcement brings four dollars back to the U.S. Treasury. HEAT Initiative Administrator Spencer Turnbull says the new focus on rooting out fraud is working.

TURNBULL: “We’re really able to get in and bring a lot of folks to justice a lot faster than historically had been the case.”

Organized crime is involved in much of the nation’s medical fraud. But doctors, hospitals, drug companies and small-time criminals are also involved.

BURNS: “Once you discover how to game the system in one hospital or one doctor’s office in one part of the country you can then take that fraud and essentially duplicate it again and again and again.

Patrick Burns is spokesman for Taxpayers Against Fraud, a non-profit that helps whistleblowers. He says anyone with a good laser printer and a post office box can defraud the federal government. But he says the worst offenders include major hospital chains and pharmaceutical companies.

BURNS: You might figure out in a small office in Oklahoma how to upcode pneumonia from a four hundred dollar charge to a four thousand dollar charge, well if that works in a doctor’s office in Oklahoma, that works in a hospital system across the nation and billions of dollars are Hoovered out of the economy.”

Burns says there still aren’t enough federal resources to take on the biggest scammers.

BURNS: “Because if you’re making three billion a year of off fraud and all you have to do is invest five hundred million dollars to keep DOJ at bay, it’s an unequal army. It’s like Custer fighting the entire Sioux nation, and we know how that turned out.”

And that’s with the extra money.

Burns says Congress remains beholden to the health care industry, and that’s why federal fraud fighters will never have enough resources.

Elizabeth Wynne Johnson – Capitol News Connection.

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