Feds Say Health Care Info Released to Fight Medicare Fraud

Federal Government Released Health Care Payment Info to Get Public’s Help with Medicare Fraud

medicare fraudOn Wednesday, April 9th, the federal government finally released information about payments from Medicare and Medicaid to doctors, and the numbers were astounding in many cases. Local reports across the country picked up on potential Medicaid and Medicare fraud in various states after parsing the numbers.

On Thursday, April 10th, representatives from various federal agencies said they decided to release the health care payment data specifically so the public, and journalists, could look through the information and help the federal government identify Medicaid and Medicare fraud.

“We know that there’s waste in the system, we know that there’s fraud in the system,” said Jonathan Blum, principal deputy administrator for the Centers for Medicare and Medicaid Services. “We want the public’s help — we want reporters’ help — with data that appear to be fraudulent.”

“For too long, this data was not public. The Medicare program is funded, by and large, with taxpayer dollars,” Blum said. There were also concerns about patient privacy, he added, which prevented the American Medical Association from releasing the data for 35 years.

“There’s some spending that just appears to be wasteful,” said Niall Brennan, acting director of CMS’ Offices of Enterprise Management. “Our goal is to sharpen the conversation. People should not jump to conclusions just by seeing spikes in spending.”

“Currently, consumers have limited information about how physicians and other health care professionals practice medicine,” said Kathleen Sebelius, secretary of Health and Human Services. “This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice.”

The Medicare information details exactly how much the federal program paid individual doctors in 2012. An analysis by The Associated Press found that a tiny group, 344 out of more than 825,000 doctors, received $3 million or more apiece, and showed that about 2% of clinicians accounted for 25% of the payments. The numbers led to serious speculation about potential Medicare fraud.

The AP findings also showed that 87 of the 344 highest-paid doctors were in Florida, a state notorious for Medicare fraud.

The AMA, however, stated that high Medicare payments do not inherently indicate Medicare fraud. For example, opthamologists and cancer doctors were in the top tiers for Medicare reimbursement, but it was not an indication of Medicaid or Medicare fraud, but instead a reflection on how expensive treatments are in those specialties.

The Strom Law Firm Protects Medicare Fraud Whistleblowers in South Carolina

It is a provision of the Federal Civil False Claims Act that allows a private citizen to file a suit, in the name of the U.S. Government, charging fraud by government contractors and other entities that receive or use government funds. Bolstered by amendments passed by Congress in 1986, the law has armed private citizens who have independent and direct knowledge of fraud, whether financial institution fraud or Medicare fraud, with a weapon to prosecute government contractors and others who are defrauding the Government.

Common whistle blower actions include:

  • Medicare fraud,
  • defense contractor fraud, and
  • other kinds of fraud against state or federal government

Qui tam lawsuits have been, and continue to be, a very effective and successful tool in combating government procurement and program fraud. If you have first-hand knowledge of government fraud occurring at your place of employment or your doctor’s office, including Medicare fraud, the attorneys at the Strom Law Firm can help protect your rights. In order to help the government provide the best possible services, Medicaid and Medicare fraud must be reported as soon as possible. The attorneys at the Strom Law Firm understand the complexity of qui tam and whistleblower suits, and we offer free, confidential consultations to discuss the facts of your case. Contact us today. 803.252.4800

About Pete Strom

Defending criminal charges including drug crimes, DUI, CDV, mail fraud, wire fraud, bank fraud, computer crimes, money laundering, and juvenile crimes, Pete also handles Federal and State investigations. Representing individuals in Civil Matters including Class Actions, Personal Injury, Qui Tam Actions, Defective Products, Nursing Home Neglect, and Professional Licensing Defense cases. Joseph Preston “Pete” Strom, Jr., the managing partner at Strom Law Firm, L.L.C., has been fighting for justice since 1984.

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