776 civil investigations; it had 1,612 criminal and 743 civil pending
-- Spending on health care already approximates 16 percent of the U.S.'s
GDP, and is expected to increase to 20 percent of GDP in the next few
-- Demographic factors make the future of compliance more complex. About
78% of all health care costs can be traced to 20 percent of all
patients -- those with chronic illness.
Attributed to Jeffrey Blumengold, FHFMA, partner in Deloitte's Forensic and Dispute Services:
"For years, the Centers for Medicare and Medicaid Services noted they had fewer than a dozen people exclusively dedicated to Medicaid fraud enforcement. They relied on the state agencies like the Medicaid Fraud Control Units within each state attorney general's office. Now, CMS have significant additional funding ($50 million in both fiscal years 2007 and 2008 and $75 million in 2009) to attack systemic fraud, waste and abuse. As a result, there is a very significant initiative at the federal level, not only to fund more fraud enforcement efforts, but also to create programs that ferret out fraud through data matching, data mining and, where necessary, the hiring of contractors to go out as third parties to look for fraud, waste, abuse or errors."
Attributed to Christopher Panczner, Esq., legal counsel, Saint Vincent Catholic Medical Centers and of counsel, Epstein Becker & Green:
"Operating an organization within the health care industry can be like
having three different customers with three sets of unaligned rules to
comply with when selling your product or service. Providers must meet the
requirements for those three specific customers (that is, Medicare,
Medicaid and commercial insurance), even when their regulations conflict.
Even in the best-run, most compliant organizations, a third-party review of
the organization's business relationships,
|SOURCE Deloitte LLP|
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