U.S. officials hunt Medicare fraud

Nov 07, 2006

U.S. federal investigators are hunting incidents of Medicare fraud, using sophisticated computer technology to determine unusual patterns.

In one case, investigators found a patient who had reportedly undergone a diagnostic rectal-probe procedure 118 times in a year at 21 medical facilities.

As one official told USA Today: "It's unlikely that could have occurred. This person would not have been able to sit on a plane."

The use of computer programs to find suspicious patterns is designed to help discover insurance fraud before payment.

Medicare investigators said they have also discovered cases in which improperly obtained Medicare patient identification numbers were used to bill for examinations that were likely never performed. Such discoveries have resulted in 83 diagnostic centers losing their Medicare billing privileges this year, with $163 million in payments denied.

Fraud is estimated to account for as much as 10 percent of the nation's $2 trillion healthcare spending bill.

Copyright 2006 by United Press International

Explore further: AbbVie shares sink after $21 bn deal for Pharmacyclics

add to favorites email to friend print save as pdf

Related Stories

Anthem breach: A gap in federal health privacy law?

Feb 06, 2015

(AP)—Insurers aren't required to encrypt consumers' data under a 1990s federal law that remains the foundation for health care privacy in the Internet age—an omission that seems striking in light of the ...

Tenet, Community Health fight gets nasty

Apr 11, 2011

(AP) -- Tenet Healthcare has charged rival hospital operator Community Health Systems with systematically bilking Medicare, and the burgeoning legal fight sent shares of the entire sector sliding Monday.

High-end medical option prompts Medicare worries

Apr 02, 2011

(AP) -- Every year, thousands of people make a deal with their doctor: I'll pay you a fixed annual fee, whether or not I need your services, and in return you'll see me the day I call, remember who I am and ...

Recommended for you

US must respond to global health outbreaks, say bioethicists

Mar 05, 2015

Last summer, West Africa fell into the grip of a deadly outbreak of Ebola that has thus far taken the lives of more than 9,500 people. The fear swept up by the epidemic quickly jumped across the Atlantic and landed in the ...

Uganda on defensive over medical 'brain drain' uproar

Mar 03, 2015

Uganda's government on Tuesday hit back at mounting criticism of plans to 'export' over 200 health workers to the Caribbean, insisting it was only seeking to regulate an existing labour market and prevent abuses.

Seth Mnookin on vaccination and public health

Mar 02, 2015

Seth Mnookin, an assistant professor of science writing and associate director of MIT's Graduate Program in Science Writing, is the author of "The Panic Virus: The True Story Behind the Vaccine-Autism Controversy" ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.