Illinois

From the office of Rep. Peter Roskam (R, Illinois 6th District)…

America’s elderly are victims of a crime spree so expansive that on an annual basis exceeds the value of all the cocaine smuggled in to North America. The crime is Medicare fraud, and it is conservatively considered to be a $50 billion industry.
While the federal government intercepts almost 40% of cocaine shipments to the United States, it stands virtually idle in apprehending Medicare fraudsters, recovering just $2.5 billion in fraudulent transactions and improper payments in 2009. Originating disproportionately from the Miami area, according to the FBI in September, “South Florida remains ground zero for healthcare fraud.” The unfortunate reality is that Medicare not only needs significant fiscal reforms to be around for future generations – like through the House Republican Budget: The Path to Prosperity – but its mechanics are also in dire need of substantive reform.

Fortunately, the solution to this crime problem is not to create another “taskforce” or “war on” anything; in part it takes adapting the proven fraud prevention mechanisms of the credit card industry – an industry suffering just .044 percent fraud out of $17 trillion in annual transactions.

This is not a failure of our law enforcement community. It is the product of Medicare’s broken “pay-and-chase” system for reimbursing claims. Medicare does not effectively guard against fraud on the front end — cutting checks without thorough fraud-check measures – so law enforcement officials must pursue fraudulent claims after reimbursement. It is the equivalent of a retail store processing a customer’s credit card approval long after the clothes have left the store. It’s nonsensical.
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We Must Put an End to Medicare Fraud”