Clinton vows to put fraud fighters on site at carriers

President’s plan could spark an anti-fraud bidding war between the White House and Congress

The Clinton administration not only wants to increase the number of federal agents who investigate Medicare fraud, it wants to put a Medicare fraud unit in the office of every Medicare contractor in the country.

President Clinton announced that proposal in his national radio address Jan. 22. He said his FY 2001 budget would also fund new technologies to track false claims. While the president's plan lacked specifics, the administration plans to propose a whopping $48 million for Medicare contractors' anti-fraud efforts.

Health Care Financing Administration (HCFA) spokesman Craig Polaski says the details of the President's plan will be released along with his budget next month.

Clinton's formula for purging fraud extends well beyond anything contemplated by Congress to date, and raises the specter of a bidding war between the two sides over who can propose a more aggressive plan."

Congress will likely release its own Medicare anti-fraud salvo this week. House Budget Committee spokesman Terry Holt says his committee is already preparing a hearing that will address Medicare overpayments.

Holt says the committee will offer up a fairly thorough report about waste and fraud across all categories of government spending that cites "a substantial error rate" in Medicare payments.

Several congressional committees have voiced skepticism over the administration's claims regarding the reduction of fraud in the Medicare program. "It is important that Medicare and Medicaid claims are filed and paid correctly," says Holt. "We will look for ways to improve those programs and tighten up the procedures."

Clinton's proposal comes as two new reports cite major inroads in reducing health care fraud.

"Perhaps the most concrete evidence of the success of anti-fraud and oversight efforts is the significant reduction in the error rates in Medicare fee-for-service payments — an overall 45% reduction in improper payments in just two years," the Department of Health and Human Services' Office of Inspector General and U.S. Department of Justice assert in their joint annual report on health care fraud and abuse control programs for FY ’99, expected to be formally released shortly.

According to the report, the Health Care Fraud and Abuse Control Program resulted in judgements and settlements totaling $524 million last year. As a result of program activities, the federal government collected $490 million in 1999, while another $4.7 million was recovered as the federal share of Medicaid restitution.

Meanwhile, the HCFA reported last week that its Medicare Integrity Program prevented $5.3 billion in inappropriate payments in the last half of 1998 and the first half of 1999, including provider audits ($1.4 billion) and prepayment activities ($2.6 billion).

The Health Care Fraud and Abuse Control Program report is expected to be published shortly on the OIG's Web site at progorg/oig/new.html.