Wednesday, August 22, 2012

Affordable Care Act boosts fight against health care fraud

NPR reported yesterday morning on the ways the Affordable Care Act helps fight health care fraud. The story noted the difficulty government regulators have in keeping up with the various health care scams that crop up continuously, describing efforts as a "an endless game of Whack-a-Mole." A very expensive game of Whack-a-Mole indeed, where the government loses an estimated $65 billion per year to health care fraud.

The Affordable Care Act could give the government a leg up in the fight by diverting an additional $340 million to anti-fraud efforts over the next decade, and calling for the use of anti-fraud computer systems, which filter through the millions of Medicare claims received daily and identify suspicious or irregular submissions. The new computer system also screens health care providers seeking to participate in Medicare based on their potential to commit fraud, thereby mitigating  risk of fraud in the future, by ensuring that the program admits honest providers.

Although the new and more sophisticated technology will undoubtedly benefit anti-fraud efforts, the value of committed individuals, including whistleblowers, cannot be overlooked.  According to Patrick Burns of Taxpayers Against Fraud, "There's only so much detective work investigators can do sitting at computer terminals. The effort also needs some foot soldiers."