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Date: Wednesday, June 3, 1998 FOR IMMEDIATE RELEASE Contact: HCFA Press Office (202) 690-6145
HHS Secretary Donna E. Shalala announced a new regulation today which will make citizens who alert Medicare of possible acts of fraud and abuse eligible for rewards if their information leads directly to the recovery of Medicare money.
"Senior citizens are our first line of defense in the battle to fight Medicare fraud. They can be our eyes and ears in the field," Shalala said. "This program is another weapon in our fight against fraud and abuse -- and protecting the Medicare Trust Fund."
The final regulation detailing the Incentive Program for Fraud and Abuse Information, created in the Health Insurance Portability and Accountability Act, is on display today at the Federal Register. Under this program, which starts in January 1999, rewards of up to $1,000 will be paid to Medicare beneficiaries and others who report fraud and abuse in the Medicare program.
"It is critical that we enlist the support of Medicare beneficiaries in our fight against health care scams and unscrupulous providers," said Nancy-Ann DeParle, administrator of the Health Care Financing Administration, which oversees Medicare. "Working with the Administration on Aging, one of our partners in Operation Restore Trust, and its national aging network across the nation, thousands of volunteers have been trained to recognize and report fraud and abuse in nursing homes and other long-term care settings as well as local communities."
"This new program underscores the continuing contributions that older Americans continue to make to our country, by enabling them to work closely with their family members, colleagues and peers to fight fraud and abuse," said Jeanette Takamura, assistant secretary for aging. "It is truly a people's campaign."
To receive a reward, the information reported on fraud and abuse must directly contribute to the recovery of Medicare funds for fraudulent activity not already under investigation by law enforcement agencies, the HHS Inspector General, state agencies or Medicare's contractors.
Rewards will be for 10 percent of the recovered overpayment or a $1,000 maximum and will be financed from the collected overpayments, after all other fines and penalties have been recovered. Program funds will be used for the administrative costs of the incentive program.
Some examples of the types of potential fraud that Medicare beneficiaries and others can help spot include Medicare being billed for services that were never provided, being billed twice for the same procedure, being billed for a more expensive procedure than the one received, or being billed for a procedure that is not medically necessary; providers using Medicare card numbers that they obtained deceptively; and telemarketing scams.
The incentive program is the latest step in the Clinton Administration's unprecedented focus on fighting Medicare fraud, waste and abuse. Medicare alone saved more than $7.5 billion through anti-fraud and abuse efforts in fiscal 1997, and with its law enforcement partners returned another $1 billion to the Medicare Trust Fund. Efforts of the highly successful Operation Restore Trust anti-fraud program identified $23 in money owed back to the Trust Fund for every $1 spent on fraud detection and recoveries. Lessons learned in that pilot project are now being applied nationwide.