Medicare, the health program for seniors, is a vast enterprise. Total spending in 2012 is estimated at $551 billion, accounting for roughly 16 percent of the federal budget. The program currently covers about 50 million beneficiaries and pays more than 4 million claims a day to some 1 million care providers and suppliers. Enrollment and spending are projected to grow rapidly as baby boomers become eligible.
With a system of such expense and complexity, it is not surprising that much effort is devoted to eliminating fraud, waste and abuse. Estimates are that fraud accounts for 3 percent to 10 percent of Medicare expenditures each year. The White House claims it has recovered $14.9 billion during the past four years in fraud, overpayments and other irregularities.
As part of the emphasis on detecting, preventing and prosecuting Medicare fraud, the Centers for Medicare and Medicaid Services plans to roll out soon a new statement form for benefits and claims history, redesigned to be easier to understand. Beneficiaries would then be better able to spot and report inaccuracies — such as bills for services they did not receive.
But even more likely to appeal to anti-fraud sensitivities is a change proposed last month that would increase dramatically rewards in the agency’s Medicare Incentive Reward Program for specific information that exposes fraud.
Currently, the program pays whistleblowers up to 10 percent, capped at $1,000, of the funds recovered. The proposed rule would raise the reward to 15 percent of recovered funds up to $66 million. In effect, a tip that pans out could yield a maximum reward of $9.9 million. Talk about an incentive to keep eyes peeled for funny business.