Department of Health and Human Services

recouping $$$ lost to MEDICARE fraud

Because of little oversight/consequences; medical providers continue to commit fraud by: overbilling Medicare,

i.e., they bill as:

1). Dr. Bill Smith; 2). PA of Dr. Smith;

3). Smith Happy Clinic;

4). Smith Health Providers, LLC,etc., so on for the SAME SERVICE.

They also bill as a "new, 1st time patient"(they get more $$ for that)--when, in fact) the pt. is an established pt. Many times,

ins. commpanies notify the state level Medical Boards/entities (overseeing state medical licensure). The states report to FED entities, and the ball is dropped ....fraud is allowed to continue, at the amount of BILLIONS OF DOLLARS!!!

IDEA: States referring fraud will notify FED agencies; the state will then AUTOMATICALLY place offending entities in suspension;(unable to continue to practice); the states will receive a BOUNTY for any recovered MEDICARE FRAUD funds recovered--this would be a factor for the states to hire personnel to develop/report FRAUD cases (state's cut to be determined, at least 25-30%); all MEDICARE payments (to accused fraudulent billers) will be suspended UNTIL all FRAUDELENTLY paid $$$s are REPAID to Medicare. IRS will also be notified and the property of any (personal included) fraudulent biller will be seized/frozen until back Medicare $$$s are repaid.

A national registry (based on Dr.s S/Ss & DEA drug information) will be established to track fraudulent billers.

New rules should be establised that NO state may issue licensening to a newly applicant to practice when the applicant owes back $$$s to Medicare for fraudulent billing.



Idea No. 18171