Archives: Enforcement

 

HHS Secretary Kathleen Sebelius addressed the New York Health Care Fraud Prevention Summit on November 5 in Brooklyn and updated attendees on the government’s efforts to rein in health care fraud. Significantly, she also indicated that CMS intends to squeeze out some of the excessive profit that is currently available to certain suppliers under Medicare. Her remarks are available here.

Appearing with Attorney General Eric Holder, Sec. Sebelius described the efforts to launch the Health Care Fraud Prevention and Enforcement Action Team, (HEAT), a joint effort between HHS and and the Justice Department to share information, spot trends, coordinate strategy, and develop new fraud prevention tools. In the past year, the two departments have hosted a National Health Care Fraud Summit  in DC and regional summits in South Florida and Los Angeles, with another planned for Detroit and more on the horizon.

She noted the creation of the a new center for Program Integrity at the Centers for Medicare and Medicaid Services and described the  Affordable Care Act, as “secretly one of the strongest fraud prevention laws in American history “ due to its provisions creating a single searchable database for all Medicare-paid claims.

She also noted the feds’ efforts to control the costs of certain DME, citing the fact that Medicare currently pays three to four times the amount paid by commercial insurers for certain medical supplies.

“As a consequence of outdated government fee schedules, Medicare spends $3,600 for a power wheelchair that costs the supplier about $1,000. We pay $6,200 in rent over 36 months for an oxygen concentrator that costs the supplier less than $600.

So the Centers for Medicare and Medicaid Services is aggressively moving forward with a program that establishes competitive bidding among medical equipment suppliers. In the first round, businesses in nine areas around the country that want to work with Medicare beneficiaries must submit bids that  Medicare will use to set the amounts it pays for certain durable medical equipment, prosthetics, orthotics and supplies.”

Finally, she noted television outreach efforts asking everyone to stay wary and watchful, ask questions, and keep track of their medical bills and payments, and highlighted a $9 million grant recently announced to fund  expansion of the Senior Medicare Patrol.