"Although federal agencies have been targeting provider companies in an effort to cease Medicare fraud, regulators oftentimes quickly reinstate licenses after having revoked them, according to an Associated Press (AP) article yesterday. Government employees and contractors frequently don't attend initial hearings when suspended companies appeal; the Centers for Medicare & Medicaid Services (CMS) declined to comment on why and whether it had to do with CMS staffing limits, according to the AP.
"Nobody from (the government) bothers to attend the appeal hearing, so the judge hears a one-sided story and the government is virtually guaranteed to lose," said Ryan Stumphauzer, a former Miami federal prosecutor. "Every taxpayer should be outraged."
With limited governmental representation at appeal hearings, provider companies can win by default, according to the article.
Fraudsters bank on Medicare's "pay and chase" approach, in which criminals receive Medicare reimbursements and then run before regulators discover the fake claims.
"If Medicare wants to stop fraud, it can't keep pretending these are real providers," said attorney Kirk Ogrosky, former head of the Justice Department's division on healthcare fraud. "Medicare is adept at enforcing technicalities because the system has been designed for real providers, but outright crooks go undetected because their claims appear legitimate."
For more information:
- read the AP article
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Thank You Fierce Healthcare and Ms Cheung, and by all means, Do, go read the AP article.
"Still, as the program has burgeoned to pay 4.4 million claims worth more than $1 billion per day"