Obama Administration Warns Providers Over Medicare Fraud

The Obama administration, reacting to recent speculative news reports from the Center for Public Integrity, among others, about alleged upcoding and other improprieties involving Medicare reimbursements, issued a warning to healthcare providers on Monday: “We will not tolerate healthcare fraud.”

The New York Times reprinted a letter mailed to provider associations such as the American Hospital Association in which Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, and U.S. Attorney General Eric Holder, warn providers that their respective agencies, in addition to the FBI and other law enforcement organizations, will be “monitoring these trends” and will take action. “Law enforcement will take appropriate steps to pursue health providers who misuse electronic health records to bill for services never provided.”

The letter states it is within the purview of CMS to “stop Medicare payments upon suspicion of fraud and to mine data to detect it in the first place.”

The Center for Public Integrity also speculated that the Obama administration’s promotion of electronic health records may have backfired, making it easier for providers to commit Medicare fraud. “As we phase-in electronic health records, we ask for your help in ensuring that these tools are not misused or abused,” the letter’s authors wrote.