Finance & Enjoyment Blog


Prevention of Fraud in Medicare Payments


In response to crimes, fines for health care fraud will increase by 20-50% for crimes involving more than $1,000,000 in losses. Also, obstructing a fraud investigation will be considered a crime. There will be an expansion of Recovery Audit Contractors to investigate Medicaid, Medicare Advantage, and Part D to ensure proper payment has been made. New powers will be given to the secretary and inspector generals to investigate and audit health insurance exchanges to prevent health insurance fraud. 

A large part of the Health Care Reform Act of 2010 was the prevention and response to fraud in regard to Medicare payments. First off, all providers and suppliers must develop compliance programs based on procedures, benchmarks, and standards that will be developed by the Department of Health and Human Services(HHS). To fund this, HHS will increase funding for fraud control by $350 million over the next ten years.

To discuss this issue and learn more, call KKB at 303-815-1100.

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