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Medicare To Hire Fraud-Busters

March 18, 1998

WASHINGTON (AP) _ Medicare is hiring accountants, bankers and other specialists from the business world to help detect fraud and abuse of the nation’s health care program for the elderly.

``No matter how tough the cheats are, we’re going to be tougher,″ Health and Human Services Secretary Donna Shalala said Tuesday.

Until now, insurance companies that processed Medicare claims were the only private contractors used to detect fraud. New rules will let the program later this year hire other experts, such as accounting firms, to help with investigations and increase public awareness of scams.

At an all-day conference, Medicare officials compared notes with anti-fraud experts from the business world, including banks and computer companies, as well as other government agencies such as the Defense Department.

``The system needs to be changed so that people feel accountable about using the government’s money to pay claims,″ said Kathleen Fyffe, who represents the Health Insurance Association of America.

Separately, President Clinton took steps to correct problems with a new law that was supposed to have guaranteed health insurance for millions of working Americans when they change jobs.

The 1996 Kassebaum-Kennedy law _ named for its sponsors, former Sen. Nancy Kassebaum Baker, R-Kan., and Sen. Edward M. Kennedy, D-Mass. _ was designed ``to give people peace of mind,″ Clinton said, but it is being undermined by insurance companies’ tactics. ``These practices have to be stopped.″

Government investigators found that insurance companies have been charging up to six times the standard premiums for people who try to use Kassebaum-Kennedy to convert their group policies to individual coverage.

Some companies are also discouraging their agents from selling policies to people with medical problems.

At a joint appearance with Democrats on Capitol Hill, Clinton said the government sent warnings to every insurance company that it is illegal to impede access to health care.

The president also promoted his plan to let people ages 55 through 64 buy early Medicare coverage by paying a premium, saying the proposal would help 300,000 to 400,000 people.

Since announcing a crackdown on Medicare fraud in 1995, the Clinton administration has been battling fraud, waste and simple error that are estimated to cost the program more than $20 billion annually.

A recent investigation in Florida found some doctors had lent their billing numbers to clinics that used them to cheat Medicare, so investigators will now check up on physicians nationwide.

``I personally visited clinics in Florida where we saw how this kind of abuse had to be stopped, and I am determined to do something about it,″ Medicare administrator Nancy-Ann Min DeParle said Tuesday.

Doctors who provide care at clinics can legally let those facilities use their Medicare billing authorization numbers to submit claims to Medicare.

But DeParle said the Florida investigation found some clinics were submitting claims using the billing numbers of doctors who had not worked there for more than two years. Others were billing Medicare for care provided by one doctor on the same day at clinics hundreds of miles apart.

In addition to the new sweep of audits, Medicare will look at whether it should limit the number of facilities a doctor can bill through.

``We need to keep working harder and smarter to catch criminals who try to stay one step ahead of every loophole we close and every scam we shut down,″ said DeParle.

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