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Healthcare Fraud, Waste, and Abuse Uncovered in Detroit

Dec 27 | 2012  by

Despite regular indictments and convictions of home health care agency owners, Medicare and Medicaid Fraud remains prevalent in metro-Detroit, according to a new report by the Office of the Inspector General (OIG).

The US Department of Health and Human Services (HHS) found high fraud, waste, and abuse in Detroit.  Other cities found to have high fraud include Chicago, Miami, Tampa, Los Angeles, Dallas, Houston, and Baton Rouge.

Fraud is a major problem in the Medicare system.  Most experts believe that up to ten percent of the annual $1 trillion cost of Medicare and Medicaid can be attributed to fraud, waste, and abuse.  In 2009, HHS created HEAT, a task force whose aim is to reduce fraud in these programs.

According to this report, as much as 22 percent of claims inspected were filed in error because the services were unnecessary or were coded inaccurately.  This resulted in $432 million in unnecessary payments to home health agencies.  Part of the problem lies in poor record-keeping by the agencies.

The OIG report made three recommendations to home health agencies to reduce fraud.  These providers should (1) increase Medicare contractor standards to identify high risk providers; (2) track license revocation recommendations; and (3) take measures to prevent inappropriate payments to agencies with suspended or revoked licenses.

In response to the report, the Centers for Medicare and Medicaid Services (CMS) said it would implement all three of these recommendations.

If you have questions about Medicaid or Medicare fraud, or other legal issues, please contact Mark Mandell or Tariq Hafeez at (248) 380-0000. To read the original article, please visit Crain’s Detroit website.