Longform

Medicare Fraud Is Sweetest Crime in South Florida

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More obvious improvements still elude the agency — even such basics as changing a beneficiary's Medicare number when theirs is stolen or used in a fraud. Others wonder why CMS hasn't mimicked credit-card companies, which flag suspicious behavior within minutes.

"I sent my staffer to Chick-fil-A with my personal credit card to charge $100 of sandwiches for our office for lunch," says Burgess. "So I'm called off the floor of the House to answer a phone call from my credit-card company saying, 'Hey, someone is trying to charge $100 worth of sandwiches.' Why can't [Medicare] do that?"

Obamacare has allocated $100 million to CMS to create a similar computer system that would employ data analytics to flag suspicious claims as soon as they're billed. The new proactive stance includes a spiffy command center in Baltimore linked to field agents. In its first full year, the system identified or prevented $115 million in fraud.

But as Burgess notes, Obamacare provided CMS with "seven new tools" to fight fraud. Four years after the law passed, CMS has managed to enact just one.

"At this rate, some point before my natural death, maybe we'll have done half of them," says the congressman.

Though most everyone agrees that the government is moving in the right direction, $100 billion continues to walk out the door each year.

"This is a lucrative business, and business is good," says Feinwachs. "The only problem is that you and I are funding it."

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Chris Parker
Contact: Chris Parker