Fighting Health Insurance and Medicare Fraud

Fighting Health Insurance and Medicare Fraud in Individual Health Insurance

Yesterday, the Obama Administration met with insurance industry representatives, law enforcement and other government officials on Thursday to discuss legislature to fight Medicare and health insurance fraud. 

According to Attorney General Eric Holder, Medicare fraud costs the government $60 billion a year. Holder and the Obama Administration say current efforts to stop fraud have not been effective enough.

The USA Today article seemed to indicate a productive meeting, which the public and private sectors agreed to proactively share data and improve coordination.

Obama also plans to expand the Health Care Fraud Prevention and Enforcement Action (HEAT), which will ramp up law enforcement efforts against fraud.  HEAT has shown that collaboration between the public and private sectors helps combat health insurance fraud and has recovered $2.2 billion in the last year. 

Some main action items in this “fraud summit” include using less-sensitive identification numbers instead of Social Security numbers and educating families about keeping information private. A “pre-payment” system has also been proposed. When fraud is suspected, the government would delay Medicaid payments to ensure its validity rather than “pay and chase” the perpetrator as it currently operates.

Holder believes coordination between HEAT and the health industry will make processes smoother and easier to enforce.

Because Medicare fraud costs the government and families so much money every year, it’s a good thing the Obama Administration is cracking down.

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