Health/Fitness :: Health

Medicare Fraud Busters Unveil Command Center

by Kelli Kennedy and Ricardo Alonso-Zaldivar
Wednesday Aug 1, 2012
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BALTIMORE (AP) - Federal fraud busters invited the news media to visit their new $3.6 million command center and watch staffers explain how they’ll jump on unfolding Medicare scams.

While the action on the tour Tuesday wasn’t real, the problem is - more than $60 billion a year is lost to fraud. And two Republican senators immediately questioned whether the new multimillion-dollar facility is just throwing more money away.

Sens. Orrin Hatch of Utah and Tom Coburn of Oklahoma said the Obama administration isn’t providing enough information about new computer systems being used to identify suspicious Medicare and Medicaid billings and as a result, no one can tell how well they’re working. Computerized screening of claims is at the heart of the command center’s mission.

The carpeting stills smells new at the facility, which opened a week ago in a nondescript commercial office park. A couple of dozen computer workstations are arrayed in concentric semicircles in front of a giant screen that can display data, slides and photos, as well as enable face-to-face communication with investigators around the country.

Medicare fraud czar Peter Budetti said the goal is to let the government’s far-flung gumshoes talk directly with the experts running the new computerized detection systems, dramatically reducing the time it takes to conduct investigations.

"Our expectation is that this center will pay for itself many times over," Budetti told reporters.

Conducting what amounted to her first formal inspection, Health and Human Services Secretary Kathleen Sebelius set the bar high for the command center. She told staffers it’s time for the government to move beyond its old strategy of "pay and chase," pursuing fraudsters after Medicare and Medicaid have already paid.

"Preventing fraud and abuse is what this effort is about," she said.

Medicare’s new antifraud computer system has been in operation for about a year, aiming to adapt tools used by credit card companies to stop theft. A report to Congress is due soon.

But Hatch and Coburn said they smell a boondoggle in the new command center. In a letter Tuesday to Sebelius, the senators said they’ve received information the video screen alone cost "several hundred thousand dollars."

"Institutionalizing relationships through establishing a (command) center may be useful, but if huge sums of money have indeed been spent on a video screen while other common-sense recommendations may have not been implemented due to ’resource concerns,’ this seems to be a case of misplaced priorities," the senators wrote.

The two Republicans may have more than congressional oversight in mind. In an election year, Medicare fraud is an issue with older voters because it speaks to the Obama administration’s stewardship of the program.

The invitation to cover the event said reporters would see "examples of real-time missions," but Medicare spokesman Brian Cook acknowledged that all they were shown were "demonstrations" of how the command center is supposed to work. The Associated Press obtained in advance the script prepared for Sebelius’ visit. Although the presentation generally followed the script, the employees Sebelius stopped to talk to were knowledgeable, and some had long experience as fraud fighters.

The secretary spoke with three groups of staffers: one responsible for developing computer models to query billing data for suspicious patterns; another in charge of investigating data generated by the computer models, looking for mistakes as well as real fraud; and a third handling coordination with law enforcement around the country. Staffers said they expect the coordination to cut the time it takes to investigate suspected fraud schemes from months to days and weeks.

The Obama administration is asking Congress for $2 million to operate the command center, part of a beefed-up campaign against health care fraud. But some efforts launched with great fanfare have not delivered convincing results. A computer system unveiled last summer to head off fraud before it happens, for example, had by Christmas stopped just one suspicious payment from going out, for $7,591.

Hatch and Coburn say the administration has yet to give a full accounting of the system. The two senators said they have repeatedly pushed for details and "the responses have been polite, but vague."

Medicare scams have grown into sophisticated networks where crooks file millions of dollars in bogus claims and take off with the money, sometimes even leaving the country, before the government has a chance to track them down.

Copyright Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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