Republicans Seek Anti-Fraud Details

Concerned About Fake Companies Billing Medicare, Medicaid
Republicans Seek Anti-Fraud Details

Four Republican healthcare leaders in Congress are questioning whether the Medicare and Medicaid programs are doing enough to crack down on shell companies submitting fraudulent claims.

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In a letter to Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services, the lawmakers ask for a description of CMS's efforts to identify individuals and organizations that establish false storefronts and shell companies - paper-only firms with no real operations - and then submit fraudulent claims.

The Republicans sent the letter expressing their concerns in the wake of a March 7 indictment that alleged a fake home care provider swindled $20 million from Medicare over five years. "This indictment, along with other examples ... demonstrate that CMS's provider screening efforts are still not effectively safeguarding the Medicare program from individuals intent on committing fraud within the Medicare program," the letter states.

The letter asks CMS to provide a list of safeguards Medicare enrollment contractors are using to verify the identity of providers and owners. And it requests an explanation of the process CMS uses "to determine which categories of providers and suppliers are deemed 'high risk' and explain why non-physician owned clinics are currently viewed as 'low risk.'"

The lawmakers who submitted the letter are Sen. Orrin Hatch, R-Utah; Sen. Tom Coburn, R-Okla.; Rep. Wally Herger, R-Calif.; and Rep. Charles Boustany, R-La.

About the Author

Howard Anderson

Howard Anderson

Former News Editor, ISMG

Anderson was news editor of Information Security Media Group and founding editor of HealthcareInfoSecurity and DataBreachToday. He has more than 40 years of journalism experience, with a focus on healthcare information technology issues. Before launching HealthcareInfoSecurity, he served as founding editor of Health Data Management magazine, where he worked for 17 years, and he served in leadership roles at several other healthcare magazines and newspapers.

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