Articles Posted in Medicare overpayment reporting

Federal prosecutors in Florida are pursuing an unusual criminal fraud case  taking aim at billing practices of Medicare Advantage plans, which are popular with seniors because out-of-pocket costs are lower and they provide more benefits than traditional Medicare.The case centers on a South Florida doctor affiliated with Humana Inc., one of the industry’s biggest players.

A federal grand jury in West Palm Beach, Fla., indicted the doctor, Isaac Kojo Anakwah Thompson, on eight counts of health care fraud on Feb. 4. He’s accused of cheating Medicare out of about $2.1 million by claiming his Humana-enrolled patients were sicker than they actually were. Thompson, 55, was arrested and is free on a $1 million bond. Through his lawyer, he declined comment.

The indictment does not accuse Humana of wrongdoing and the company has repaid the Government.

Improper Medicare payments and fraud cost the taxpayers in excess of $50 billion last year alone, according to a report by Health and Human Services. Medicare spent over $554 billion last year.

The Centers for Medicare and Medicaid Services (CMS) has instituted new programs to prevent fraud and has started to screen 1.5 million Medicare suppliers. So far over 160,000 providers have had their billing privileges deactivated .

The latest budget requests $428 million for Medicare fraud prevention programs that could yield $13.5 billion in savings.

Health care providers are required to report and refund any overpayment of Medicare/Medicaid funds within 60 days after the overpayment was identified. Failure to do so is a direct violation of the False Claims Act and all of its fines, penalties on top of recovered moneys. A lack of vigilance in this area carries heavy risk.