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GAO: CMS Must Improve Medicare, Medicaid Anti-Fraud Efforts

Watchdog Agency Makes Recommendations for Fighting Billing Fraud
The Department of Health and Human Services has taken important steps to fight Medicare and Medicaid fraud, but it can further strengthen its efforts in several ways, according to a new government watchdog agency report. The Government Accountability Office estimates that in fiscal 2016, improper Medicare and Medicaid payments totaled about $95 billion.
Fighting healthcare fraud clearly is a complex issue that requires a multifaceted approach.

“Medicaid reimbursements are notoriously low. Crooks use this as motivation to ‘game’ the system,” says Kerry McConnell, partner and principal consultant at tw-Security, who has previously worked in Medicaid claims processing. “Crooks get greedy and then they get flagged, caught. More training to identify fraud can’t hurt, but technical tools are more effective.”


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