Lewis Morris, the Chief Counsel to the Office of the Inspector General (OIG) of HHS provided testimony this morning before the subcommittes on Health & Oversight of the U.S. House Ways and Means Committee. The text of Mr. Morris’s message provides insight into successful fraud and abuse intitatives by the OIG as well as the success of combined initiatives, as well as insight into future fraud efforts that have been enabled by the Patient Protection and Affordable Care Act (ACA).
In an excerpt from his prepared remarks Mr. Morris describes health care fraud:
Health care fraud schemes commonly include billing for services that were not provided or were not medically necessary, purposely billing for a higher level of service than what was provided, misreporting costs or other data to increase payments, paying kickbacks, and/or stealing providers’ or beneficiaries’ identities. The perpetrators of these schemes range from street criminals, who believe it is safer and more profitable to steal from Medicare than trafficking in illegal drugs, to Fortune 500 companies that pay kickbacks to physicians in return for referrals.
Also clarified in his testimony is the fact that the ACA authorizes the Secretary
to require providers and suppliers to adopt, as a condition of enrollment, compliance programs that meet a core set of requirements, to be developed in consultation with OIG. In addition, the ACA requires skilled nursing facilities and nursing facilities to implement compliance and ethics programs, also in consultation with OIG. These new requirements are consistent with OIG’s longstanding view that well-designed compliance programs can be an effective tool for promoting compliance and preventing fraud and abuse.
While this testimony is for the purpose of updating the noted sub-committees, it is also a concise read for providers to keep them up to date on fraud and abuse initiatives.