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Medicare, Medicaid body gets serious about fraud prevention

Feb 09, 2011 Matt Roesly

The Center for Medicare and Medicaid Services is buckling down on fraud prevention by implementing new practices that will feature background screening for providers and new regulations that will freeze payments to individuals suspected of fraud.
 The mission also covers the Children's Health Insurance Program, and aims to significantly decrease the amount of wasted money going to ineligible recipients. Background screening measures will be threefold, including "limited risk providers" such as physicians, nonphysican practitioners and medical groups and clinics, as well as "moderate risk providers" such as outpatient rehab centers, independent diagnostic testing centers and home health agencies. The third group will include "high risk providers," including makers of prosthetics, orthotics suppliers and others. All will undergo identity verification and submit to fingerprint analysis. New measures are being installed soon after a report from healthcare officials stated that $4 billion in Medicare fraud was recouped in 2010. The same group estimates that Medicare and Medicaid are hit by $60 billion to $90 billion in fraud each year, CBS News reports.