Medicare Fraud Investigations Likely Victim of Budget Cuts By Tod Aronovitz | 07/08/13 | 0 Comment

The number of Medicaid and Medicare fraud investigations is expected to drop as the Department of Health and Human Services struggles with budget cuts and reduced staffing levels.

The agency’s Office of Inspector General (OIG) is set to lose 400 staff members in the next two years from its peak of 1,800 in 2012. These auditors, evaluators, investigators and attorneys work to uncover fraudulent schemes by examining payment issues and investigating whistleblower complaints.

In addition to staffing, budgetary issues are coming to light, and sequestration is only part of the dilemma. According to a statement by HHS, the OIG has “significantly reduced” funds as a result of an expiring $30 million per year appropriation from the Deficit Reduction Act of 2005 and the end of stimulus funding.

Gary Cantrell, Deputy Inspector General for the OIG Office of Investigations, said at a June 24 hearing of the Senate Committee on Homeland Security and Governmental Affairs, that his unit “is shrinking” even as the federal Medicare and Medicaid programs grow in size and complexity, limiting their ability to expand oversight in some of these areas.

What does this mean for the crackdown on Medicare and Medicaid fraud?

Although officials are deciding the fate of each investigation, the existing staff is so maxed out that it hasn’t been able to act on 1,200 complaints of alleged wrongdoing over the past year, according to the OIG, and the that number is expected to rise. One project that may be up for a cutback is the program to “identify fraud and abuse vulnerabilities” in electronic health records. The federal government is spending almost $36 billion in economic stimulus funds to help doctors and hospitals integrate the digital technology necessary to cut down on duplicative tests, making health care more efficient and less pricey.

With a reduction in staff, the public becomes even more important in the fight against health care fraud.

Medicare beneficiaries will be receiving new statements that make it easier for them to spot discrepancies, as we reported in our June 20 blog post, “Florida Ranks First in Medicare Revocations; Seniors Urged to be Vigilant and Report Fraud.” In addition, CMS announced a proposal in April that would increase rewards— up to $9.9 million – paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds.

How to Report Miami Medicare Fraud
Healthcare or medical billing employees who have inside knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with Miami whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss a case.