GAO Finds $60B Medicare Errors——23,400 Potentially Fraudulent Physician Address, Including Dozens Of Practice Locations Inside UPS Mailing Stores!

By Bankrupting America

On July 21, The Government Accountability Office (GAO) announced the systems Centers for Medicare Medicaid Services (CMS) uses to detect fraud and abuse might not be working properly. According to the report, “Two of CMS’s procedures appear to be working to screen for providers and suppliers listed as deceased or excluded from participating in federal programs or health care– related programs. However, GAO identified the following weaknesses in the other two procedures: CMS’s verification of provider practice location and physician licensure status.” Today’s Top 5 Things To Know will take a closer look at the report.


  1. In Total, Medicare Paid $554.2 Billion For Health Care And Health Care-Related Services During Fiscal Year 2014. According to the GAO, “Medicare is the federally financed health-insurance program for persons age 65 or over, certain individuals with disabilities, and individuals with end-stage renal disease.1 In fiscal year 2014, Medicare paid $554.2 billion for health care and health care–related services.”


  1. CMS Estimated That Roughly $59.9 Billion, Or 10.8 Percent Was Paid Out Improperly Leading To Medicare Being Classified As A “High-Error” Program. The GAO reported, “According to the Centers for Medicare Medicaid Services (CMS)—the agency within the Department of Health and Human Services (HHS) that administers the Medicare program—an estimated $59.9 billion (10.8 percent) of that total was paid improperly, which is an increase over the 2013 level. Due to the large dollar amount involved in improper payments, the Office of Management and Budget has placed Medicare on its list of high-error programs.”


  1. CMS Requires Doctors Who Receive Benefits Or Reimbursements For Medicare Funds To Be Registered As A Part Of The Provider Enrollment, Chain And Ownership System (PECOS). According to the GAO audit, “CMS requires prospective providers and suppliers to be listed in the Provider Enrollment, Chain and Ownership

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