Medicare Fraud Prevention

“MR. SMITH,” CONVICTED MEDICARE FRAUD FELON

JOHN M. FRAZZINI, Former Investigator, PSI

JOHN E. HARTWIG, Deputy Inspector General for Investigations, HHS-OIG

SUSAN A. FRISCO, Special Agent, New York Field Office, HHS-OIG

CATHY E. COLTON, Asst. I.G. Investigations, (Atlanta/Miami), HHS-OIG

H. DONNA DYMON, PhD., Nurse Consultant, San Francisco Region IX, HCFA

DEWEY PRICE, Team Leader, Operation Restore Trust, Miami Satellite Office, HCFA

Health care comprises about 1/7th of the nation’s economy, and it is clear from published reports and criminal prosecutions that fraud, waste, abuse and mismanagement are part of this system. And government financed programs are no exception. Medicare — one of the largest and fastest growing entitlement in the federal government — is also subject to significant waste fraud and abuse. The HHS-IG’s Office estimated that as much as $23 billion is paid each year by the Medicare Program in improper payments. Because of this vulnerability to waste and fraud, the GAO has identified Medicare as one of the federal government’s high risk programs, that is, a program subject to a risk of waste, fraud and abuse. The Subcommittee initiated a comprehensive investigation of the waste, fraud, abuse and mismanagement in government health insurance programs, including Medicare. The investigation is focused on fraud in the procurement of durable medical equipment, home care services, HMO marketing abuses, and nursing home certification and regulation, among other areas. An overview hearing was held on June 26, 1997. Officials from the FBI, GAO, HHS Inspector General’s Office, HCFA and the private sector testified about the growing problem of fraud in the Medicare program.

A second hearing was held on January 29th, 1998, regarding the enrollment procedures and processes for Medicare providers. The Subcommittee received testimony from a convicted Medicare fraud felon, PSI Investigators, representatives of the HHS Inspector General’s Office as well as employees of the Health Care Financing Administration (HCFA).