Medicare Recommendations for Healthcare Fraud Prevention and Awareness Month

Posted on September 12, 2014
September may be Healthcare Fraud Prevention and Awareness Month, but GAO tracks this issue year round. Because the Medicare program is particularly susceptible to fraud, waste, and abuse, it has been on our High Risk list since we started compiling the list in 1990. As a result, we have made numerous recommendations to help protect and improve the program. For Healthcare Fraud Prevention and Awareness Month, here’s a look at some of our open recommendations to the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare. To better protect the program and beneficiaries, we recommended that CMS
  • take Social Security numbers off of Medicare cards. More than 50 million Medicare cards display beneficiaries’ Social Security numbers and, although CMS has explored options for removing the numbers from those cards, it needs to move forward with a plan.
And it’s not just fraud we worry about. Waste and abuse are also concerns. To address those issues, we’ve also recommended that CMS
  • reduce payments to self-referring physicians. GAO has found that physicians who have a financial stake in the services they’re providing—such as imaging services and certain prostate cancer therapy—have higher rates of referral and utilization of those services. CMS needs to better identify claims from physicians who self-refer, reduce payments for certain self-referred services, and, for certain services, disclose physicians’ financial interests to patients.
  • use more prepayment edits to automatically deny certain Medicare claims. CMS saved Medicare at least $1.76 billion in fiscal year 2010 through the use of prepayment edits, but those savings could have been greater if such edits been more widely used.
Interested in learning more? Check out our Medicare High Risk and key issues pages. Curious about other open recommendations? Search our open recommendations database.