Senate Hearing: Healthcare Fraud a ‘Pervasive Problem

by Administrator

Criminal enterprises are a pervasive problem in fraud schemes involving home health, durable medical equipment, prescription drugs, transportation and medical clinic settings, and the government is taking steps to stem some of these problems, according to testimony in a Senate hearing.

Health and Human Services Deputy Inspector for Investigations Gary Cantrell outlined an example of an illegal operation of a $100 million Medicare billing ring. The defendants stole the identities of physicians and thousands of Medicare beneficiaries and operated 188 phony clinics in 25 states to submit Medicare claim forms for reimbursement. The ring leader was sentenced to 37 months in prison. In another case, a pharmacy chain owner submitted false claims for prescription refills.

Deputy Director and Administrator Sean Cavanaugh of the Centers for Medicare and Medicaid Services also spoke at the hearing “Protecting Seniors from Identity Theft: Is the Federal Government Doing Enough?,” noting that by April 2019 CMS will eliminate the use of beneficiaries’ Social Security Numbers as the primary identifier on Medicare cards by replacing it with a Medicare Beneficiary Identifier, or MBI. CMS will be able to terminate a MBI as soon as it’s been confirmed compromised in an effort to curb fraud.

Cavanaugh called the initiative to remove SSNs from Medicare cards a “substantial undertaking,” requiring the coordination of many stakeholders and conducting an outreach campaign for beneficiaries, providers and others.

He advises that beneficiaries:

Guard personal identification such as MBI and SSNs and only share them with providers, plans and others approved by Medicare;
Do not give personal information to anyone who calls or comes to the door uninvited, including individuals claiming to be conducting a health survey;
Check medical bills for accuracy;
Be suspicious of anyone who offers free medical equipment or services. If it is free, they do not need a Medicare number; and
Do not let anyone borrow or use a Medicare ID card in exchange for goods or services. This is illegal.

The US Senate Special Committee on Aging offers a fraud hotline, call 1-855-303-9470 to report abuse or submit online via the Aging Committee's fraud reporting page.


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