CMS To Fight Medicare, Medicaid Fraud With High-Tech 'Bounty Hunters'

Medicare and Medicaid fraud cost American taxpayers some $54 billion last year. (We've long believed that Medicare fraud is the unofficial state sport of Florida.) CMS has tried many approaches to catching some of the perpetrators, notably through the Recovery Audit Contractor program, but the bad guys always seem to be one step ahead of the G-men.


The Obama administration wants to go high-tech in its pursuit of fraudsters, sending out "bounty hunter auditors" to find waste, fraud and abuse in Medicare and Medicaid, according to the Huffington Post.

"We're told the auditor's weapons will be sophisticated new computer programs to scan Medicare and Medicaid billing records nationwide to check for patterns of bogus claims," writes columnist Diane Dimond. "And like the early bounty hunters of the old West these modern day crime fighters will get to keep a percentage of what they recoup for taxpayers. It seems like a win-win idea. Pilot programs in California, New York and Texas over the last three years re-captured $900 million that would have otherwise gone into the crook's pockets."

The administration estimates such cybersleuths could recover at least $2 billion in wasteful and fraudulent spending over the next three years. If fraud continues at its current pace, that's less than 1.5 percent of the $162 billion CMS will squander in that three-year period, but hey, it's a start, right?

FierceHealthCare IT
10-22-2010