Taking action against health fraud in the USA

Last updated: 19 March 2014

It’s no secret that fraud, waste and abuse is running rampant within the US Medicare system. It’s a serious problem no matter how you look at it, but especially in light of the debt situation this country is currently facing. Happily, there are solutions to impede Medicare fraud which would save US taxpayers billions of dollars every year.

I feel privileged to testify before the United States House of Representatives Energy and Commerce –Subcommittee on Health tomorrow morning, Wednesday November 28, on this very important issue.  Speaking on behalf of the Secure ID Coalition, I will discuss solutions to the problems that plague the Medicare system.

You can find more information about the hearing at which I will appear as a witness, “Examining Options to Combat Health Care Waste, Fraud and Abuse” here. Be sure to check back at http://energycommerce.house.gov/ tomorrow morning where you can view the hearing live via Web cast. It will also be archived for later viewing.

The Centers for Medicare and Medicaid Services (CMS) reports that the US Medicare program suffers more than $60 billion in fraud every year through practices such as:

  • Phantom billing – in which an unscrupulous medical provider bills Medicare for unnecessary or unperformed procedures, medical tests, or equipment (or for equipment that is billed as new but is, in fact, used).
  • Durable medical equipment abuse – can occur when medical equipment used in the home, such as wheelchairs or oxygen tents, are billed many times over, while in fact nothing has been delivered to an actual patient.
  • Improper payment – These payments either should not have been made or were made in an incorrect amount.  Improper payments also include payments sent to the wrong recipient or payments where supporting documentation is not available.
  • Fraudulent patient billing – can occur when a patient provides his or her Medicare number to a provider in exchange for kickbacks. The provider bills Medicare for any reason and the patient is told to admit that he or she indeed received the medical treatment, whether or not it actually occurred.
  • Passed-off or stolen Medicare cards – used by others to get medical care.

It can be hard to imagine that these practices are occurring in such great numbers, but this is reality. By simply modernizing the Medicare card, we can cut fraud in half (at least $30 billion every year!) while also protecting our senior citizens and ensuring that Medicare will be available to future US citizens.

The Secure ID Coalition is committed to combating Medicare fraud and supporting legislation that will put much needed solutions into place. Medicare fraud currently affects over 48 million senior citizens, and this number will only increase if we don’t do something now. Please do share your perspectives below on this important healthcare issue that affects all US citizens, if you’d like to join the debate.