Challenges Remain on the Health Care Fraud Front for U.S. Government

Health care fraud remains a major target as the Obama administration aims to bring fraudsters to justice, especially since the Affordable Care Act went into effect this year. It’s easy to see why it has been such a focus of the organization — in 2013 alone, federal investigators recovered $4.2 billion in health care fraud penalties, a record for a single year. That number equals $14.9 billion over the past four years. This has resulted in a return of $8 for every dollar invested in anti-fraud investigations.

However, there are still plenty of challenges for the federal government ahead in terms of combating health care fraud. While the government is doing its best to fight back against the crime on many different fronts all at once, there are some sophisticated and widely organized gangs of fraudsters that have in-depth infiltration networks, particularly in locations like Houston, South Florida and Detroit.

Some steps taken by the federal government recently to combat fraud in health care include:

  • Predictive analysis that allows the department of Health and Human Service to spot fraudulent Medicare payments in real time
  • New regulations that force tougher screening of providers seeking Medicare reimbursement
  • Targeted “strike forces” aimed at tackling organized rings of fraudulent activity

That last point is particularly important, as more investigations are revealing foreign mobsters working in units to target both federal programs and private insurers. In one high-profile case, an Armenian ring based out in California defrauded insurers for more than $160 million before the government caught up to them in 2013.

It’s clear that the federal government is doing everything that it can to take down health care fraud. With this in mind, medical providers that require guidance in the issue of health care fraud should consult the New Jersey health care attorneys at Buttaci Leardi & Werner, LLC.

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Posted in: Regulation