HHS offers rewards for fraud whistle-blowers
HHS offers rewards for fraud whistle-blowers
A new regulation will make citizens who alert Medicare to possible acts of fraud and abuse eligible for rewards if their information leads directly to the recovery of Medicare money.
"Senior citizens are our first line of defense in the battle to fight Medicare fraud," Health and Human Services Secretary Donna E. Shalala said in announcing the program. "They can be our eyes and ears in the field. This program is another weapon in our fight against fraud and abuse - and protecting the Medicare Trust Fund."
This final regulation detailing the Incentive Program for Fraud and Abuse Information, created as part of the Health Insurance Portability and Accountability Act, was published in the June 3, 1998, Federal Register.
Program begins in six months
Under the program, which starts in January 1999, rewards of up to $1,000 will be paid to Medicare beneficiaries and others who report fraud and abuse in the Medicare program.
"It is critical that we enlist the support of Medicare beneficiaries in our fight against health care scams and unscrupulous providers," says Nancy-Ann DeParle, administrator of the Health Care Financing Administration, which oversees Medicare. "Working with the Administration on Aging, one of our partners in Operation Restore Trust, and its national aging network across the nation, thousands of volunteers have been trained to recognize and report fraud and abuse in nursing homes and other long-term care settings as well as local communities."
To receive a reward, the information reported on fraud and abuse must contribute directly to the recovery of Medicare funds for fraudulent activity not already under investigation by law enforcement agencies, the HHS Inspector General, state agencies, or Medicare's contractors.
Rewards will be for 10% of the recovered overpayment or a $1,000 maximum, and they will be financed from the collected overpayments after all other fines and penalties have been recovered. Program funds will be used for the administrative costs of the incentive program.
Some examples of the types of potential fraud that Medicare beneficiaries and others can help spot include:
o Medicare being billed for services that were never provided;
o being billed twice for the same procedure;
o being billed for a more expensive procedure than the one received;
o being billed for a procedure that is not medically necessary;
o providers using Medicare card numbers that they obtained deceptively;
o telemarketing scams.
The incentive program is the latest step in the Clinton administration's focus on fighting Medicare fraud, waste, and abuse. Medicare alone saved more than $7.5 billion through anti-fraud and abuse efforts in fiscal year 1997 and, with its law enforcement partners, returned another $1 billion to the Medicare Trust Fund. Efforts of the highly successful Operation Restore Trust anti-fraud program identified $23 owed the Trust Fund for every $1 spent on fraud detection and recoveries. Lessons learned in that pilot project now are being applied nationwide.
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