Medicare fraud growing due to design of IT systems

Federal officials are justifiably worried over the costs fraud imposes on the Medicare system. However, it seems that the claims processing systems Medicare has in place are doing little to address the problem. As a recent report in the Washington Post notes, Medicare actually pays the vast majority of bills it gets from any company that has a federally-issued supplier number. The audit systems now in place focus on overbilling and inappropriate medical treatment rather than detecting fraud, observers note. One example of this is the case of Rita Campos Ramirez who, using only a laptop, filed more than 140,000 Medicare claims for unnecessary equipment and services. Campos Ramirez, who has pled guilty to filing false claims, has since helped prosecutors win indictments against doctors and patients who accepted kickbacks for pretending to receive HIV infusion services.

CMS says that it has tightened up its anti-fraud efforts substantially over the past year, pulling the billing numbers of nearly 900 companies that didn't seem kosher. It also has imposed new monitoring protocols in high-fraud areas, as well as setting standards preventing people with felony convictions from ever receiving a Medicare number. However, it sounds as though some significant systems upgrades are in order too!

To learn more about this trend:
- read this piece from The Washington Post

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