The Obama Administration has focused on reform for both financial institutions as well as individuals who abuse the Medicare system. The administration has put extra attention into monitoring Medicare so that it can fix the system in which billions of dollars are stolen from taxpayers every year by scam artists who work for the health care industry. In his town hall meetings, the president has threatened to arrest and prosecute people engaging in Medicare fraud. The stats show that he has stepped up oversight on medical providers defrauding the government dramatically more than the previous administration.
Medicare fraud crackdowns by the Obama Administration began to make the news as far back as 2010, but the massive stings began in May 2012 when officials arrested 107 health care professionals for fraud that cost the government over $450 million. Then on October 4, 2012 the administration announced the second major crackdown on professionals in the health care industry involving Medicare fraud. The charges against 91 doctors, nurses and other health professionals were based on false billing that amounted to $430 million. The arrests occurred in several cities such as Los Angeles, Chicago, Houston, Dallas and Miami.
Part of the complaint was that these medical professionals were billing the government for ambulance services in California that didn’t need to happen. The government also accuses these individuals of writing medical prescriptions for patients who didn’t need them and paying kickbacks to patients who entered programs that their hospitals could bill the government for. Part of the reason for the crackdown is the administration’s effort to cut health care costs for his national health care program.
The federal government announced in February 2013 that it had recovered $4.2 billion from medical billing fraud. Kathleen Sebelious, Secretary of Health and Human Services, credited new provisions of the Affordable Care Act, also known as Obamacare, as the key to these crackdowns. She said that the government was gaining the upper hand against health care criminals. In 2011 the federal government recovered $4.1 billion.
Since Obama took office in 2009 the amount of health care fraud money recovered has been $14.9 billion. President George W. Bush’s second administration only collected $6.7 billion in health care fraud recovery. According to the government 826 individuals were convicted of false medical billing in the past year. One of the convicts, Armando Gonzales, was sentenced to 14 years for defrauding the government out of $64 million.
The FBI reported in 2012 that of the $2.5 trillion that the government spends on health care every year, up to ten percent goes to medical frauds, amounting to as much as $250 billion per year. The number doubled when Forbes reported in May 2012 that Medicare and Medicaid fraud was costing American taxpayers $500 billion or more. According to Forbes, the federal crackdown on health care providers had been going on since 2007 in the Bush Administration. Part of that crackdown was that a third of the businesses collecting Medicare funds did not exist.
The Forbes article went on to speculate that forty percent of New York City’s Medicaid payments were questionable. According to the Office of Inspector General the five states struggling with Medicaid fraud the most are California, New York, Texas, Ohio and Kentucky. Sebelius says that now the government is analyzing claims data patterns instead of just looking at each individual claim. Insurers in the private sector who use software also help spot anomalies. The administration will likely continue its strong stance against health care fraud for the remainder of Obama’s term. Consulting with ethical, healthcare professionals can also help, especially those who have completed an online rn bsn program.