Medicare Fraud Report: $521B Annual Fraud Deficit

A new Medicare fraud report is out. The federal government loses as much as $521 billion per year from fraudulent schemes, a report by the Government Accountability Office found. That accounts for 7% of the federal  budget. One of the worst areas of fraud is in the medical field. More than half of fraud discovered in 2023 was Medicare fraud.

The government’s primary weapon against fraud is the whistleblower. Whistleblower programs offer rewards and protections that incentivize insiders to expose fraud. Contacting an attorney is the best way to take advantage of those programs. An attorney can ensure that the investigation goes through an appropriate channel, that a whistleblower’s rights are protected, and that a whistleblower receives compensation for their assistance. A Medicare fraud report originates with whistleblowers.

If you have information about a company that has committed Medicare fraud or other kinds of fraud, contact us and we will evaluate your case with you.

Here are some take-aways from the report:

• Undetected Fraud May Be Significant. In March 2024, the Department of Health and Human Services Office of Inspector General (HHS OIG) issued a consumer alert related to scams that involve obtaining a Medicare enrollee’s personal information and then billing for unnecessary, low-cost medical equipment. Related media reported that an alleged fraud ring may have used the scheme to overbill Medicare for more than $2 billion since 2022. It is alleged the fraud ring employed multiple small charges to many victims to help avoid detection.
• The Centers for Medicare & Medicaid Services Fraud Prevention System uses predictive models and other algorithms to identify medical providers and suppliers exhibiting a pattern of behavior indicative of potential fraud.
• Sole source acquisition can be at higher risk of fraud due to the lack of competition.
• Defense (DOD) OIG reported at least $1.1 billion in confirmed fraud in fiscal year 2021.

source: GAO Report 2024