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HHS Increases Rewards for Reporting Medicare Fraud to Nearly $10 Million

New funds available to expand Senior Medicare Patrol Program (Apr. 24)

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius has announced a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million. In addition, funds released this month support the expansion of Senior Medicare Patrol (SMP) activities to educate Medicare beneficiaries on how to prevent, detect, and report Medicare fraud, waste, and abuse.

According to the HHS, the administration has recovered more than $14.9 billion in fraud during the last 3 years. Under the proposed changes, a person that provides specific information leading to the recovery of funds may be eligible to receive a reward of 15% of the amount recovered, up to nearly $10 million. The HHS currently offers a reward of 10%, up to $1,000, under the current incentive reward program. The changes are modeled on an IRS program that has returned $2 billion in fraud since 2003.

The proposed rule would also strengthen certain provider enrollment provisions, including allowing the HHS to deny the enrollment of providers who are affiliated with an entity that has an unpaid Medicare debt; to deny or revoke billing privileges for individuals with felony convictions; and to revoke privileges for providers and suppliers who are abusing their billing privileges.

The SMP is a national, volunteer-based program that enables Medicare beneficiaries to prevent and report Medicare fraud, waste, and abuse. Since 1997, more than 3.5 million beneficiaries have learned how to recognize and fight fraud and abuse, and more than 7,000 referrals have been made to the Centers for Medicare & Medicaid Services (CMS) and to the Office of the Inspector General for investigation, the HHS says.

Source: HHS; April 24, 2013.

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