Significant Obstacles Facing Health Care Fraud Units in South Florida
Earlier this summer, Medicare shut down the widely successful South Florida Medicare Fraud Hotline. The hotline led over 1,000 fraud investigations and identified millions of dollars in potential public funds lost in health care fraud operations, but it was ultimately shut down because it was deemed to have been unnecessary. The questionable nature of this decision illustrates the difficulties facing the ramped up efforts for health care fraud investigations throughout the country. Healthcare fraud is a rampant issue for the U.S. Medicare program; its costs alone are overcharged at about 10% or $60 billion of the total costs of Medicare each year. Most of the money that is lost is never recovered by the government. In an attempt to increase recovery measures for health care fraud operations, the federal government has poured tons of money, time, and experience into getting these investigations up in running. However, a broken system that is in need of reform will most likely continue to hamper the efforts to recover public funds that have been stolen through health care fraud.
The Expansion of Health Care Fraud Investigations
The Obama administration has focused its antifraud efforts on traditional measures, including the creation of nine federal strike forces that are supposed to produce coordinated responses across jurisdictions and agencies. Recently in the news, antifraud strike forces in Detroit, Miami, and Brooklyn announced that they were charging a total of 90 people who had participated in over $260 million in fraudulent health care charges. The other traditional measure has been the use of private contractors, which has led to the scattered nature of the current antifraud health care investigation regime. Medicare specifically relies on a broad range of independent contractors who handle claims, review potential instances of healthcare cost overbilling, and specialize in investigating potential cases of fraud.
Problems With the Expanded Health Care Fraud Investigation Process
The current health care fraud investigation process has been accused of being inefficient and dysfunctional because the different parties involved are in constant competition and do not effectively communicate with each other. Though increased efforts are being taken to combat healthcare fraud, last year only $4.3 billion was recovered of the $60 billion in Medicare funds lost to fraud. Part of the issue with the current system is that an assortment of diverse private contractors are utilized to carry out government operations. These contractors are poorly managed with minimal government oversight, vulnerable to changing political climates, and full of conflicts of interest. Furthermore, hospital resistance to private contractors, as well as an unsustainable appeals process has prevented even the most successful private contractors from operating effectively, thus seriously stalling recovery efforts. The closing of the successful Medicare Fraud hotline in fraud-rife South Florida is an example of how even successful efforts can be quickly halted because a government agency determines that it is no longer necessary. While the hotline was able to respond to phone calls with 48 hours, those who now have to call Medicare directly must wait months before a complaint is addressed.
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