Epress.am News from Armenia
The words ‘Medicare fraud’ conjure pictures of shady doctors, forged paperwork, and unwitting little old ladies – not Armenian mobsters, illegal guns, and Klingon swords. But all those things were at the heart of one incident that was part of the $4 billion Medicaid fraud crackdown Obama administration officials touted on Monday.
The Justice Department estimated that a suspected ring of Armenian-American mobsters fraudulently billed Medicare for $163 million. In October, a joint federal task force busted the ring, arresting 53 in what the DOJ called the single largest fraud scheme perpetrated by a single criminal enterprise.
However, a new regulation issued Monday will allow Medicare officials to stop payment on suspected fraudsters, but will also give law enforcement new tools to mine claims and other data to identify the really bad guys, reports Politico.
Taken together, the rule will give the agency and law enforcement further tools to prevent fraud and abuse from happening and stop the “pay and chase” mentality that has frustrated federal fraud fighters for years.
It also allows Medicaid and CHIP plans to bar from participation any provider that has been banned by Medicare. It allows Medicare and Medicaid officials to freeze enrollment into either program if they identify trends suggesting fraud in a given region or by benefit category.