Press Releases

HHS WOULD INCREASE REWARDS FOR REPORTING FRAUD TO NEARLY $10 MILLION

HHS WOULD INCREASE REWARDS FOR REPORTING FRAUD TO NEARLY $10 MILLION
NEW FUNDS ALSO AVAILABLE TO EXPAND THE SENIOR MEDICARE PATROL PROGRAM

Health and Human Services Secretary Kathleen Sebelius today announced a proposed rule that would increase rewards paid to Medicare beneficiaries and other individuals whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million. A new funding opportunity, also released this month, supports the expansion of Senior Medicare Patrol activities to educate Medicare beneficiaries on how to prevent, detect and report Medicare fraud, waste and abuse.

“President Obama has made the elimination of fraud, waste and abuse, particularly in health care, a top priority for the administration,” said Secretary Sebelius.  “Today’s announcement is a signal to Medicare beneficiaries and caregivers, who are on the frontlines of this fight, that they are critical partners in helping protect taxpayer dollars.”

Over the last three years we have recovered over $14.9 billion in fraud.  Some of this has resulted from fraud reporting by individuals –a proven tool for the government to detect fraud, waste and abuse in the Medicare program.  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 percent of the amount recovered up to $10 million.  HHS currently offers a reward of 10 percent 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 HHS to deny enrollment of providers who are  affiliated with an entity that has unpaid Medicare debt, deny or revoke billing privileges for individuals with felony convictions , and revoke providers and suppliers who are abusing their billing privileges.

The Senior Medicare Patrol (SMP) is a national, volunteer-based program that empowers 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 CMS and the Office of the Inspector General for investigation. To expand the SMP program’s capacity to reach more Medicare beneficiaries, the Administration for Community Living has issued a new Funding Opportunity.  Each of the current 54 SMP projects is eligible for varying funding levels, up to a total of $7.3 million across the program.

These proposed changes will support the administration’s comprehensive approach to program integrity, including the work being done with the Health Care Fraud Prevention and Enforcement Action Team, a joint effort by HHS and the Department of Justice to fight health care fraud that recovered a record $4.2 billion in taxpayer dollars in Fiscal Year (FY) 2012.

To read a fact sheet about today’s proposed rule visit:

To see the proposed rule visit: https://www.federalregister.gov/public-inspection

To learn more about Senior Medicare Patrols visit: http://aoa.gov/AoA_Programs/Elder_Rights/SMP/

To see the funding opportunity announcement visit: http://www.acl.gov/Funding_Opportunities/Announcements/docs/2013/HHS-2013-ACL-AOA-SP-0049.pdf

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