Wednesday, October 30, 2013

Fwd: qotd: GAO report on fraud and abuse

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-------- Original Message --------
Subject: qotd: GAO report on fraud and abuse
Date: Wed, 30 Oct 2013 15:01:04 -0700
From: Don McCanne <>
To: Quote-of-the-Day <>

September 2013
Health Care Fraud and Abuse Control Program

In fiscal year 2012, the Department of Health and Human Services (HHS),
HHS Office of Inspector General (HHS-OIG), and the Department of Justice
(DOJ) obligated approximately $583.6 million to fund Health Care Fraud
and Abuse Control (HCFAC) program activities.

HHS, HHS-OIG, and DOJ use several indicators to assess HCFAC activities,
as well as to inform decision-makers about how to allocate resources and
prioritize those activities. For example, in addition to other
indicators, the United States Attorneys' Offices use indicators related
to criminal prosecutions, including the number of defendants charged and
the number of convictions. Additionally, many of the indicators that
HHS, HHS-OIG, and DOJ use—such as the dollar amount recovered as a
result of fraud cases—reflect the collective work of multiple agencies
since these agencies work many health care fraud cases jointly. Outputs
from some key indicators have changed in recent years. For example,
according to the fiscal year 2012 HCFAC report, the
return-on-investment—the amount of money returned to the government as a
result of HCFAC activities compared with the funding appropriated to
conduct those activities—has increased from $4.90 returned for every
$1.00 invested for fiscal years 2006- 2008 to $7.90 returned for every
$1.00 invested for fiscal years 2010-2012.

GAO report (70 pages):

Comment: You frequently hear people say that we could control health
care costs if we were to get rid of fraud and abuse, as if efforts were
not already underway to do so. Our government is spending over half a
billion dollars on fraud detection with a recovery of almost eight
dollars for every dollar spent.

Furthermore, fraud is being detected in earlier stages, preventing
further loss, which is more effective than limiting recovery to "pay and
chase" approaches (trying to recover losses after the funds were
distributed). Also, CMS was able to revoke or deactivate the billing
privileges of tens of thousands of providers that did not meet Medicare

The point is that we can't let single payer opponents dismiss the need
for the adoption of more efficient health care financing methods by
saying that we merely need to eliminate fraud and abuse. We need single
payer if we are going to achieve real savings.

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