Medicare To Use New Fraud Identification Tool

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Gov Info Security: "The Centers for Medicare & Medicaid Services is the first agency to use a new fraud mapping tool that ultimately will be used throughout the federal government. The Recovery Accountability and Transparency Board, which monitors distribution of federal funds under the American Recovery and Reinvestment Act, developed the program, which it has been using to guard against improper stimulus payments. ... Medicare and Medicaid combined had about $65 billion in improper payments in fiscal 2009, [OMB Director Peter] Orszag noted. President Obama has set a goal of cutting the improper payment rate for Medicare in half by 2012" (Anderson, 6/23).

Meanwhile, several news outlets report on recent fraud investigations.

Dallas Morning News: "A Rio Grande Valley legislator has been indicted in connection with an alleged scheme to defraud the state-federal Medicaid program. Rep. Tara Rios Ybarra, D-South Padre Island, is one of four dentists named in a federal indictment that alleges one of them, an oral surgeon, paid kickbacks to the others to get referrals of their patients. The surgeon then allegedly billed Medicaid for services never provided or provided by unlicensed employees, according to an Associated Press story. ... The fraud probe involving Rios Ybarra could add momentum to a business-backed campaign to repeal a 2003 law giving the Valley special treatment on Medicaid managed care." Rios Ybarra declined to comment to reporters (Garrett, 6/23).

The Augusta Chronicle: "The U.S. Attorney's Office has filed a civil suit against prominent Augusta businessman Julian Osbon and a company he was involved with for allegedly defrauding Medicare of more than $690,000. Osbon is accused of using Augusta Medical Systems to bill Medicare for thousands of 'vacuum erection devices' for over a year when the company did not have a valid Medicare billing number, according to a statement from the U.S. Attorney's Office for the Southern District of Georgia. ... Osbon made his fortune with the vacuum devices in the years before pills to treat erectile dysfunction became widely available in the 1990s. He sold the rights to the pioneer medical device in 1995. He also sold Augusta Medical Systems and is no longer involved with the company." Osbon said he is "not guilty of anything" and is cooperating with investigators (Corwin, 6/23).

Detroit Free Press: "The owner and the vice president of a metro Detroit physical therapy clinic [Bernice Brown and Daniel Smorynski] both were convicted Tuesday in U.S. District Court in Detroit following a six-day jury trial for their part in a $23-million Medicare fraud scheme, federal authorities said. ... According to the FBI, Brown purchased fake physical and occupational therapy files from contractors, then she and Smorynski billed the services reflected in the bogus files to Medicare between October 2002 and January 2007 as if the services had been provided by her company" (Angel, Brasier and Laitner, 6/23).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

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