Medicare Advantage plans face significant risks of fraud, OIG says

Medicare Advantage plans should be aware of fraudsters turning their efforts to private plans, HHS' Inspector General Christi Grimm said. 

Ms. Grimm spoke March 15 at the Rise Conference, a gathering of Medicare Advantage professionals. 

In her remarks, Ms. Grimm said targeted fraud can quickly jump from fee-for-service Medicare to private Medicare Advantage plans. 

In one case, a fraudulent medical brace company was prevented from billing Medicare Part B by HHS' Office of Inspector General's enforcement. The company then shifted its efforts to billing Medicare Advantage plans. 

"We know from experience that fraudsters pay close attention to industry trends and — most importantly — to where the money is," Ms. Grimm said. "The risk of provider-level fraud will increase as program enrollment continues to grow." 

As fraud schemes grow more sophisticated, Medicare Advantage plans can benefit from closer cooperation with OIG and law enforcement and sharing information about fraud risk with other plans, Ms. Grimm said. 

"We can aid in identifying broader trends before they can metastasize and take enforcement action to hold wrongdoers accountable," Ms. Grimm said in her remarks. 

Read more here. 

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