Combating Fraud under the Patient Protection and Affordable Care Act

Representing Clients In Atlanta, Augusta, Columbus, Macon, Savannah, Gainesville & Throughout Georgia

Some official estimates put the annual loss from Medicare fraud at levels as high as $60 billion. Taxpayers, of course, foot the bill when Medicare and Medicaid scammers take advantage of the system. While there is substantial ground left to be covered, 2010 saw the recovery of a record amount of stolen public Medicare funds thanks to strategies outlined in the Patient Protection and Affordable Care Act.

A $4 Billion Recovery

Health fraud can take many different forms: From making claims for nonexistent medical equipment to intentional overbilling, scammers are constantly poised to take advantage of any gap in Medicare or Medicaid oversight.

However, in 2010, $4 billion in illegally obtained payments were seized back by government officials, thanks in large part to over 1,000 criminal investigations. Officials cite the cooperative efforts of the FBI, the Department of Health and Human Services, and the Department of Justice for the record-breaking fraud recovery.

The Patient Protection and Affordable Care Act sets out a number of steps that promise to make 2011 an even better year for fraud recovery:

  • Heightened penalties for health care scammers
  • More stringent screening requirements for medical providers who plan to participate in Medicare or Medicaid
  • Stopping payments to subjects under investigation

In addition, "predictive modeling" systems that utilize data and algorithms to identify con artists before payments are made are now being implemented to help fight Medicare and Medicaid fraud.

Whistleblower Savings

Government investigators are not the only ones empowered to expose misuse of public health funds: Individuals or organizations can file whistleblower claims if they have knowledge of fraudulent activity. For example, the law firm of Watkins, Lourie, Roll & Chance, PC, recently secured a $600 million whistleblower settlement against Allergan, Inc. for inappropriate marketing practices of promoting Botox for "off-label" uses.

The Allergan whistleblower case and other qui tam actions against fraudulent practices can save taxpayers substantial sums. If you have witnessed misuse of Medicare or Medicaid funds, step forward and contact an attorney to find out how you can make a difference.