High-risk patients to fall under more scrutiny

February 25, 2011

The government is continuing its commitment to stopping fraud by instituting more advanced screening and prevention techniques as part of the Patient Protection and Affordable Care Act.

The government is continuing its commitment to stopping fraud by instituting more advanced screening and prevention techniques as part of the Patient Protection and Affordable Care Act.

Providers wishing to participate in Medicare, Medicaid, and Children's Health Insurance Program will endure more detailed screening, and any enrollees who are identified as high risk for fraud will be scrutinized more closely. A new enrollment process requires states to screen enrollees for past fraud, and any identified offenders will be ineligible to participate.

New software will allow Medicare and states to identify trends among providers and suppliers that could be evidence of fraudulent activity. In addition, the government can temporarily suspend payment to any provider thought to be engaging in fraudulent activity once there is a legitimate allegation.