Technology helps anti-fraud efforts, but some say it's still not enough

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Sen. Orrin Hatch (R-UT)
Sen. Orrin Hatch (R-UT)
Federal officials testified Tuesday at a Senate hearing that they have made significant strides in cracking down on healthcare fraud and abuse, though at least one prominent Republican said that not enough has been done.

Law enforcement agencies began 977 new investigations of civil healthcare fraud and recovered $4.1 billion in fraudulent healthcare claims in fiscal year 2011. This is the highest annual amount ever recovered from individuals and companies through the Health Care Fraud and Abuse Control program, testified Daniel Levinson, Department of Health and Human Services Inspector General, at a Senate Finance Committee hearing.

Medicare Strike Force cases have been investigated and prosecuted faster, and data analytics have allowed easier identification of co-conspirators, Levinson said. He highlighted a $25 million fraud case in Miami involving ABC Home Health and Florida Home Health that resulted in 50 people being convicted.

But Sen. Orrin Hatch (R-UT) said that the Centers for Medicare & Medicaid Services has a long way to go.

“While CMS has begun to make some strides in its fight against fraud, its implementation of congressionally mandated program integrity efforts has been lackluster at best. The CMS report card is not one to be proud of,” Hatch said. “CMS has not put in any temporary moratoriums to prevent new providers or suppliers from enrolling and billing the Medicare program, even in areas where more than enough already exist to furnish healthcare services.”

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