Health Care Fraud and Abuse: Hearing Before the Human Resources and Intergovernmental Relations Subcommittee of the Committee on Government Operations, House of Representatives, One Hundred Second Congress, Second Session, May 7, 1992U.S. Government Printing Office, 1993 - 172 pages |
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administrative agencies ANTI-KICKBACK STATUTE antitrust Appendix I Vulnerable beneficiaries billed Medicare Billions to Fraud carriers Chairman Civil Division commission COORDINATION copayments CRAIG THOMAS crime Criminal Division DELAURO Department of Justice detection dollars drugs durable medical equipment efforts example facilities False Claims False Claims Act Federal fraud and abuse Fraud Control Units fraudulent billings fraudulent providers GERSON HCFA Health and Human health care fraud health care providers health care system health insurance fraud hearing HOSPITALS Human Services identify increase Inspector insurance companies investigative involved issues kickbacks LABORATORY law enforcement Medicaid Fraud Control medical equipment medical necessity Medicare and Medicaid MEDICARE PROGRAM national health Office operating Payers Lose Billions PAYMENT percent private insurers private payers problem prosecution prosecutorial PROVIDER NUMBERS recovered regulations REIMBURSEMENT scheme SHIKLES single-payer SUBCOMMITTEE submitted SUPPLIERS Ted Weiss tests Thank United States Attorneys Urgenson Vulnerable Payers Lose WEISS ZELIFF
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Page 9 - Shikles follows:] United States General Accounting Office GAO Testimony Before the Subcommittee on Human Resources and Intergovernmental Relations, Committee on Government Operations, House of Representatives For Release on Delivery Expected ;ii 10:00 A.TH..
Page 34 - DEPARTMENT OF HEALTH AND HUMAN SERVICES BEFORE THE SUBCOMMITTEE ON HUMAN RESOURCES AND INTERGOVERNMENTAL RELATIONS COMMITTEE ON GOVERNMENT OPERATIONS US HOUSE OF REPRESENTATIVES JUNE 6.
Page 14 - ... billing practices that include misrepresenting or overcharging with respect to services delivered. Both result in unnecessary costs to the insurer; but fraud generally involves a willful act, whereas abuse typically involves actions that are inconsistent with acceptable business and medical practices. As a practical matter, whether and how a wrongful act is addressed can depend on the size of the financial loss incurred and the quality of the evidence establishing intent. For example, small claims...
Page 15 - Schemes of this nature highlight several serious problems facing public and private payers. First, large financial losses to the health care system can occur as a result of even a single scheme. Second, fraudulent providers can bill insurers with relative ease. Third, efforts to prosecute and recover losses from 16 those involved in the schemes are costly.
Page 8 - Despite the commonality of fraud and abuse problems, diverse and autonomous insurers have few means of collaborating systematically to solve them. In our view, if the efforts of independent private payers, public payers, and state insurance and licensing agencies as well as state and federal law enforcement agencies were more coordinated, the attack on health care fraud and abuse would be more fruitful.
Page 164 - July 1991). Fraud and abuse controls in the Federal Employees Health Benefits Program were reviewed. GAO recommended changes to internal controls and program oversight that would minimize vulnerability to fraud and abuse. Medicare Claims Processing: HCFA Can Reduce the Disruptions Caused by Replacing Contractors (GAO/HRD-SI-M, Apr.
Page 9 - Mr. Chairman, this concludes my statement, and I would be happy to answer any questions you may have.
Page 163 - ... the Office of Inspector General in the Department of Health and Human Services, the Federal Bureau of Investigation, and the Office of Postal Inspections.
Page 107 - LINDA BAXTER AND TOM EWTON. IN THIS CASE, EACH APPLIED FOR TWO PROVIDER NUMBERS. THE COMPANIES — WHICH WERE ESSENTIALLY PAPER OPERATIONS — BILLED MEDICARE FOR TREATING THE SAME PATIENTS AND PROVIDING THE SAME EQUIPMENT. WE OBTAINED CONVICTIONS AGAINST THEM ON CHARGES OF MEDICARE FRAUD.
Page 11 - May 1992 report cited earlier, structural issues such as limitations on information sharing among insurers and incompatible data systems allow unscrupulous providers to move from one insurer to another. The complex issues involved in developing remedies present a dilemma to policymakers: on the one hand, safeguards must be adequate for prevention, detection, and pursuit; on the other, they must not be unduly burdensome or intrusive for policyholders, providers, insurers, and law enforcement officials.