Another $60 Billion in Improper Payments by Medicare in 2014

A Government Accountability Office (GAO) report found that nearly $60 billion in payments from Medicare in 2014 went to doctors with bad addresses or disciplinary actions. Thousands of medical providers were identified in the government probe.

The GAO reportedly used USPS records, site visits and Google Maps to check the payment addresses in the Medicare system. It found 23,400 improper locations out of the 105,234 in the database. A deputy administrator for CMS indicated that much of the problem data was simply poor documentation rather than fraudulent payments.

Medicare has already kicked out 34,000 providers since February 2011. The 2010 Affordable Care Act (ObamaCare) partly required the overhaul of Medicare’s enrollment system and provider verification which Centers for Medicare and Medicaid Services (CMS) has been performing for the past five years.

The GAO also found more than 100 cases through March 2013 where the provider was licensed in one state but had a disciplinary action against them in another and yet continued to receive government payments.

If any payments were made improperly in violation of the False Claims Act, the government should be able to clawback the payouts under the treble damages provisions of the whistleblower law.

In related news, a group of oncologists at cancer hospitals criticized soaring drug prices. As their patients are fighting a deadly illness, they are being bankrupted by the out-of-pocket costs. They are calling for regulations to limit this problem. Prescription drug prices increased more than 12% last year. New cancer drug prices are particularly on a tear, with prices increasing more than five fold over 15 years. Medicare also said that new medications will increase drug spending 9.7% between 2015 and 2024.

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