HHS seeks retired professionals to root out Medicare fraud

In its quest to eliminate fraud in Medicare and Medicaid billing, the U.S. Department of Health and Human Services (HHS) hopes to attract retired professionals to root out abuses in the sprawling federal health care payments system.

HHS Secretary Donna E. Shalala announced in June $2 million in grants for a new two-year program that will recruit and train retired professionals, including accountants, doctors, nurses, investigators, law enforcement personnel, and teachers to work with Medicare and Medicaid beneficiaries in identifying fraud, waste, and abuse in those programs. The positions will be unpaid.

Grants were awarded to agencies in Rhode Island, California, Pennsylvania, Wisconsin, Missouri, Hawaii, Iowa, Maryland, Minnesota, New Hampshire, New York, and Illinois.

Volunteers will work in their own communities and in local senior centers to identify deceptive health care practices such as overbilling, overcharging, and providing unnecessary or inappropriate services, according to the HHS.

The retired professionals will be given thorough training on how the Medicare and Medicaid programs work, says Kathy Cubit, director of program management for the Coalition of Advocates for the Rights of the Inform Elderly in Philadelphia, one of the twelve state agencies that will receive a portion of the grant.

Rather than fanning out as ad hoc investigators to randomly target hospitals’ medical records, the volunteers will respond to individual complaints. Outreach groups will work with the elderly in local communities to educate them on Medicare and Medicaid billing issues. If a Medicare or Medicaid recipient suspects fraud, he or she can contact these volunteers through their local senior center or elder advocacy group. The volunteers will then investigate the complaint.

"We’re hopeful we’ll get some [retired] government employees, some [retired] HCFA employees," says LaVerne Naesea, MSW, chief of client services and long-term care for the Maryland Office on Aging in Baltimore, another recipient of the HHS grant. Naesea, who is the project’s grants manager for her agency, hopes to get the program off the ground Sept. 1.