Wednesday, July 30, 2014
PLACERVILLE, CALIFORNIA
99 CENTS

Healthcare fraud hurts everyone

By
From page B14 | October 28, 2011 |

People talk a lot these days about the rising cost of healthcare.

How much of a role does fraud play in this?

A significant one, unfortunately.

The fact is that criminals steal billions of dollars each year from Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). This is taxpayer money that should be going to medical treatment for some of our most vulnerable citizens, including seniors, low income families, and kids.

Fraud hurts everyone by driving up healthcare costs. It also undermines the financial sustainability of federal healthcare programs upon which millions of Americans depend.

What’s the federal government doing to stop it? Plenty, especially with the new tools we have under last year’s health reform law.

For one thing, we’re becoming more proactive about keeping criminals out of federal healthcare programs in the first place.

The Centers for Medicare and Medicaid Services (CMS), has adopted a more rigorous screening process for new providers and suppliers. This is intended to weed out crooks before they can start submitting fraudulent bills to the government.

Under the Affordable Care Act, we can now use sophisticated new technologies and innovative data sources to identify patterns associated with fraud. We also have the authority to temporarily stop enrolling new providers and suppliers when we detect patterns that may indicate a significant potential for fraud.

When there’s a credible allegation of fraud against a provider or supplier, we can temporarily stop payments to them while an investigation is undertaken.

In other words, CMS is moving away from the old “pay and chase” model of doing business — paying out claims and then trying to recover the fraudulent ones.

Of course, we know that most providers — doctors, hospitals, nursing homes, home health care operators, and others — are honest. But we’re becoming more vigilant about the dishonest few. And those who defraud federal healthcare programs will face tougher penalties.

The Affordable Care Act increases the federal sentencing guidelines related to healthcare fraud offenses involving $1 million or more in losses to federal programs.

The Act also allows the government to impose stronger civil and monetary penalties against those who commit fraud. And crooks kicked out of one state’s Medicaid or CHIP program will now be kicked out of all states’ Medicaid or CHIP programs.

Is Medicare making progress in the fight against fraud?

Yes, we are.

For example, the federal government recovered $4 billion last year from people who attempted to defraud seniors and taxpayers. That’s a record amount.

How can individuals help in the fight against healthcare fraud?

If you have Medicare, here are some things you can do:

• Guard your Medicare and Social Security numbers. Treat them like you treat your credit cards. Criminals use these numbers to send the government bogus medical bills — in your name.

• Hang up the phone if someone calls and asks for your Medicare number, Social Security number, or bank or credit card information. Medicare will NEVER call and ask for this information, and we will NEVER call you or come to your home uninvited to sell Medicare products.

• Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. It’s illegal, and it’s not worth it.

• Don’t let anyone borrow or pay you to use your Medicare ID card or your identity.

• Check your Medicare claims for errors. Look at your Medicare Summary Notice or statements from your Medicare plan.

• If your Medicare Summary Notice shows billings for goods or services that you never received, call us at 1-800-MEDICARE (1-800-633-4227). The sooner you see and report suspected fraud, the sooner we can stop it. TTY users should call 1-877-486-2048.

David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).

Comments

comments

.

News

 
District 2 candidate statements tell of goals

By Dawn Hodson | From Page: A1

Sand Fire nears containment: 66 structures destroyed

By Cole Mayer | From Page: A1 | Gallery

 
Tails wagging over dog park approval

By Julie Samrick | From Page: A3

Quarter-acre fire in Kelsey

By Rebecca Murphy | From Page: A3

 
Schedule for Highway 50 blasting closures

By News Release | From Page: A3

.

Opinion

My Turn: Privatization of public services

By Mark Belden | From Page: A4

 
Policy book

By Mountain Democrat | From Page: A4

 
.

Letters

GDPUD management report

By Letters to the Editor | From Page: A5

 
District 2 supervisorial special election

By Letters to the Editor | From Page: A5, 3 Comments

Piano replaced

By Letters to the Editor | From Page: A5

 
Comments sign-in policy

By Letters to the Editor | From Page: A5, 1 Comment

Save the Guinea Worm

By Letters to the Editor | From Page: A5, 1 Comment

 
Large bangs

By Letters to the Editor | From Page: A5, 2 Comments

Private property gets no respect

By Letters to the Editor | From Page: A5, 1 Comment

 
.

Sports

Taz pull through for SSL trophy

By Patty Pope | From Page: A8

 
Ex-Bruin lends a helping hand

By Steven Shaff | From Page: A8 | Gallery

Sierra Sharks finish middle of the pack

By Democrat Staff | From Page: A8

 
Roundup: July 29, 2014

By Democrat Staff | From Page: A8

.

Prospecting

Nuns discover a pleasant place

By Lexi Boeger | From Page: B1 | Gallery

 
Bargains can be found everywhere

By Democrat Staff | From Page: B2 | Gallery

At a glance: Game time

By Mimi Escabar | From Page: B2

 
Barbecue dinner to benefit Blue Star Moms

By Mount Aukum Winery | From Page: B2

Stagecoach story takes riders on a trip

By Wendy Schultz | From Page: B3

 
Help needed to make cool ties

By Sew 4 | From Page: B3

Stroke and osteoporosis screenings planned

By Life Line Screening | From Page: B3

 
Gold Rush Days activities cancelled this year

By Sacramento Convention And Visitors Center | From Page: B4

Master Food Preservers: Tomato time

By Monique Wilber | From Page: B4

 
Build an author platform at the Library

By El Dorado | From Page: B5

 
Sacramento area museums offer summer fun

By Sacramento Association Of Museums | From Page: B5

.

Essentials

Weather stats 7-29-14

By Michael Raffety | From Page: A2

 
Building permits 6/2-6/2014

By Michael Raffety | From Page: A2Comments are off for this post

Crime Log: July 17

By Cole Mayer | From Page: A2

 
.

Obituaries

Merlyn Wilbur Adams

By Contributor | From Page: A2

 
Lisa Oliver Rose

By Contributor | From Page: A2

Wallace Murrel Thomas

By Contributor | From Page: A2

 
.

Real Estate

.

Comics

.

Women’s Health

Love the skin you’re in

By Noel Stack | From Page: WH4

Dump stress and improve your health, productivity

By Wendy Schultz | From Page: WH7Comments are off for this post

Women’s Health Expo

By Marshall Medical | From Page: WH8

Find the confidence you need to fight back

By Special to the Democrat | From Page: WH12

Our choices directly affect our health

By Special to the Democrat | From Page: WH14

They’re NOT your mother’s hearing devices!

By Marshall Medical | From Page: WH17