The Affordable Care Act (ACA) gave the federal government expanded authority and new tools to detect fraud and to increase punishment for those who commit it The anti-fraud budget was increased, and there are more personnel working in this area.
The Centers for Medicare & Medicaid Services now is able to screen questionable providers and suppliers more effectively before they become Medicare providers as well as stop payments to suspect providers. The law also established the Center for Program Integrity, which serves as the focal point for claims data for all federal and state-funded health programs to detect fraud criminals and prevent fraud systemwide.
The ACA also expands the Recovery Audit Contractors (RACs) program to help identify and recover over and underpayments to Medicare providers and also requires providers, suppliers, Medicare Advantage (Part C) plans, and Part D plans to report and return Medicare overpayments within 60 days.
The ACA increased the federal sentencing guidelines for health care fraud offenses by 20-50 percent for crimes that involve more than $1,000,000 in losses and makes obstructing an investigation related to fraud a crime. It also makes it easier for the Department of Justice to investigate potential fraud or wrongdoing at facilities like nursing homes.
Related FAQs
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