Whistleblowers Help Recover $2.5 Billion in Medicare Fraud

January 25th, 2011 / John Schilling / 0 comments

In 1996 Medicare overpayments (including fraud, error, and waste) was reported at $23 billion. Today the reported Health care fraud to the Medicare program is estimated at $60 billion. This is a staggering 260% increase of Medicare fraud over 15 years. One may ask what is being done to stop the bleeding of the Medicare program which is funded by the U.S. Taxpayer?

One great tool being used is the False Claims Act which allows private citizens (whistleblowers) to file civil lawsuits against providers committing fraud against the Medicare and Medicaid programs. Whistleblowers , according to a recent article published in the USA TODAY http://www.jconline.com/article/20110123/NEWS09/110123016 assisted the government recover $2.5 billion in the 2010 federal fiscal year. The article also indicated the government recovered a total of $4 billion. This recovery of $4 billion is still only about 7% of the fraud taking place.

Since 1996 Medicare has implemented a variety of Medicare reimbursement changes and stronger enforcement of compliance, however the fraud continues to grow. In the USA TODAY article it is reported changes under the new healthcare law will save an additional $4.9 billion over 10 years. Will it? I am skeptical. This $4.9 billion savings is only a small fraction of the fraud being committed.

Whistleblowers and the False Claims Act are still the best tools in fighting Medicare fraud.