| More inter-agency cooperation needed to help combat Medicare fraud
One of the ongoing challenges in the fight against health care fraud, including Medicare fraud and Medicaid fraud, is to foster strong ties and lines of communication between governmental agencies, both on the state and federal level, who are waging the war to stem the growing tide of this fraud.
One telling statistic includes the fact that more than 60 percent of medical providers banned from state Medicaid programs in 2004 and 2005 did not appear in the federal database of state-banned providers.
This data came out of the annual report issued by the Office of Inspector General, US Department of Health and Human Services in fiscal year 2007. What it means is that a provider who is banned in one state feels reasonably confident that he may set up shop in another state and not be detected.
State Medicaid fraud control units possess laudable investigatory resources and abilities and readily communicate them. In fiscal year 2007, 805 of the 3308 persons and corporations denied participation in Medicare and Medicaid and other federal health care programs resulted from background information provided by state Medicaid fraud control units.
Finally, all 50 state Medicaid fraud control programs collectively garnered more than 1,200 convictions and recovered more than $1.1 billion in the form of fines, civil settlements, penalties and court-ordered restitution with more than 600 successful civil actions in fiscal year 2007, according to the Office of Inspector General’s report cited above.
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