Medicare Fraud From an Investigator’s Perspective
April 26th, 2011
The testimony before the U.S. House of Representatives Committee on Oversight & Government Reform, Subcommittee on Health Care, District of Columbia, Census and the National Archives, of Gerald T. Roy, Deputy Inspector General for Investigations with the OIG, has been published and is available for review.
This testimony gives a perspective on Medicare and Medicaid fraud, waste and abuse from the point of view of an investigator who has been involved in pursuing and prosecuting fraud cases for almost twenty years, beginning with the efforts of the Clinton administration. He provides interesting insight into which means of Medicare fraud have changed over the years, especially with the expanding role of technology, and which means remain tried-and-true favorites.
Some insight is also given into how Medicare schemes are uncovered and investigated, as well as what remedial or punitive measures are taken. His testimony focuses on large corporate perpetrators and organized crime, rather than small private practitioners. Roy reports that efforts to curtail fraud and create increasing deterrents to its profitability have expanded in recent years, with admirable results; however, he also offers some ideas to prevent fraud up-front, such as strengthening requirements for becoming a participating provider and decreasing the response time to investigate possible fraud.
To read the entire transcript, see http://oig.hhs.gov/testimony/docs/2011/Roy_Testimony_04052011.pdf
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