Federal anti-fraud teams are using sophisticated computer systems and funding from the Affordable Care Act to better identify individuals seeking to defraud Medicare, NPR's "Shots" reports.
Previous estimates show that as much as $65 billion of the $750 billion paid annually to Medicare providers is lost to fraud.
However, ACA and other legislation directed federal officials to start using advanced anti-fraud computer systems that can sift through millions of Medicare claims daily to identify suspicious billing patterns.
Peter Budetti, who oversees CMS' anti-fraud efforts, said the systems are similar to those used by credit card companies. "We're able to now verify whether a person was being treated by two different physicians in two different states on the same day or a variety of other possibilities," Budetti said.
Lou Saccoccio, head of the National Health Care Anti-Fraud Association, said the advanced computer systems are part of CMS' efforts to shift from a so-called "pay-and-chase" strategy to a fraud prevention model.
Over the next 10 years, Congress is expected to distribute about $340 million in additional funding to government anti-fraud initiatives (Varney, "Shots," NPR, 8/21).