By Jessica Eisenbrey
Medicare fraud in the United States is estimated to cost taxpayers about $50 billion annually or 10 percent of the total cost of the program.
In an effort to stop this abuse, Sen. Tom Carper, D-Del, and Rep. John Carney, D-Del, have signed on to sponsor the Fighting Fraud and Abuse to Save Taxpayer Dollars (FAST) Act.
“It’s a common-sense approach to cutting fraud and abuse,” said Rep. Carney.
Both Rep. Carney and Sen. Carper came to Dover’s Modern Maturity Center Tuesday to highlight the impact the bill could have on reducing waste and fraud in Medicare.
“People say we shouldn’t touch Medicare, but we can get a better result for less money,” said Sen. Carper. “This doesn’t mean touching benefits.”
Sen. Carper introduced the bill in the Senate on June 21 with Sen. Tom Coburn, R-Okla. Thirty-three members of the Senate have signed on to co-sponsor the FAST Act. Rep. Carney introduced a similar bill in the House on Nov. 9 with Rep. Peter Roskam, R-Ill.
Two areas of fraud and abuse within Medicare that are being targeted by the FAST Act include: •Incidences where deceased doctors have approved the purchase of medical equipment and supplies and billed to Medicare, and •Medicare benefi ciaries that have been found going to six or more doctors and multiple pharmacies for the same type of controlled substance. These benefi ciaries were then either using the drugs or selling them on the street.
Other examples include instances where individuals have been responsible for billing Medicare for billions of dollars in services that were never provided.
“There’s actually a lot of organized crime in Medicare and Medicaid,” Rep. Carney said.
The FAST Act would prevent these circumstances from occurring by expanding inter-governmental fraud data sharing, stopping physician identity theft, enacting tougher Medicare fraud penalties and using predictive modeling technology to stop paying fraudulent Medicare claims.
This predictive modeling would “detect behavior that seems unusual,” Sen. Carper said.
Joining Sen. Carper and Rep. Carney at the Modern Maturity Center Tuesday was Cynthia Allen, administrator for the Delaware Partners of the Senior Medicare Patrol Program. The state’s Senior Medicare Patrol Program works in Delaware to prevent Medicare abuse and fraud.
“What we do is go out and educate seniors about problems and concerns in the Medicare program,” Ms. Allen said.
An example of Medicare abuse in Delaware that Ms. Allen provided involved a Delaware Medicare recipient being billed $12,000 in one month for hospice care.
The bill ultimately paid by Medicare for the hospice care was just $4,000, said Ms. Allen.
“We were able to help these folks and educate them more about hospice and Medicare,” she said, of the Medicare recipient involved.
So far this year the program has referred $25,000 for further action, produced $13,000 in cost avoidance and recouped $2,500 for Medicare.
Under the FAST Act the Senior Medicare Patrol, which is a national program, would have more responsibility and an incentivebased program for identifying and reporting cases of fraud.