From international law firm Arnold Porter LLP comes timely views on current regulatory and legislative topics that weigh on the minds of today’s physicians and health care executives.
If a recent proposal from CMS is implemented, Medicare beneficiaries or other individuals who provide tips about suspected fraud that lead to the successful recovery of funds may be entitled to a reward of up to $9.9 million, depending on the size of the government’s recovery.
This rule would represent a dramatic change to the agency’s existing Incentive Rewards Program, which currently offers a maximum award of just $1,000 for actionable information. The agency also has announced a new funding opportunity that will make up to $7.3 million available to support the expansion of Senior Medicare Patrol (SMP) activities. The SMP program is a national, volunteer-based program that empowers Medicare beneficiaries to prevent and report fraud, waste, and abuse. This program has trained more than 3.5 million beneficiaries since 1997 and has generated more than 7,000 referrals to CMS and the Office of Inspector General (OIG).
These changes highlight, yet again, that fraud reporting by individuals is a proven tool for the government to detect fraud, waste and abuse in the Medicare program. According to CMS, “[p]ublic involvement in … anti-fraud efforts is critical because alert and vigilant providers, beneficiaries, family members, and caregivers are able to detect and prevent fraud as it occurs.” The agency also has noted, however, that “many people do not report suspected fraud because they are not monitoring claims submitted to Medicare for their care, or noticed a suspicious claim but were not motivated to report.” These new financial incentives are expected to provide the extra motivation to increase the number of tips, reports, and whistleblower claims fielded by federal, state and private attorneys.
While these reports may ultimately help CMS and the OIG detect and correct some of the more obvious instances of fraud and abuse across the industry, these programs are also likely to result in any number of unfounded allegations that providers and manufacturers will have to spend valuable time and resources to address.
Ted Lotchin, JD, MPH, can be reached at Arnold Porter LLP, 555 12th St. NW, Washington, DC 20004-1206; 202-942-5250; email: Ted.Lotchin@aporter.com