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Better Data Just Saved Taxpayers $900 Million in Medicare Fraud

U.S. Attorney General Loretta Lynch

U.S. Attorney General Loretta Lynch // Mark Thiessen/AP

This week, the Justice Department announced the largest fraud takedown in Medicare’s history, resulting in criminal and civil charges for 301 individuals accused of participating in health care fraud schemes totaling $900 million.

It was a major effort that included personnel from the FBI and various Health and Human Services Department personnel, including the Medicare Fraud Strike Force.

But the key to these improving crackdown efforts – which have recouped billions in taxpayer dollars in recent years – isn’t just more manpower.

HHS recently hired a chief data officer and has aggressive plans for a cadre of new data gurus.

“Data can be the unsung hero,” said Caryl Brzymialkiewicz, chief data officer and assistant inspector general at HHS, speaking Thursday at an event hosted by Nextgov.

The quality of Medicare data and the suite of tools available to fraud experts sifting through it have increased, netting increasingly larger criminal stings along the way. A $700 million takedown of 243 alleged criminals last June was labeled the “largest criminal health care fraud takedown” in DOJ history by Attorney General Loretta Lynch. That is, until it was surpassed significantly by this year’s effort.

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“It’s encouraging for me to see the success we’re having with a proactive approach to data analytics,” Brzymialkiewicz said.

It’s important for the taxpayers’ bottom line, too.

As reported by Marketplace, the government loses some 12 percent of Medicare spending and 10 percent of Medicaid fraud on improper payments, which last year cost taxpayers $70 billion.

For that reason, Medicaid and Medicare fraud has been a frequent target of the Government Accountability Office as well. The $900 million recaptured this week might seem like a small piece of the fraudulent pie, but Brzymialkiewicz said it’s a clear sign technology is helping the bureaucratic behemoth begin to get ahead of fraudsters and criminals.

Recent criminal busts, she said, have already had a “deterrent effect,” reducing expected claims payments made criminally or fraudulently by $1 billion.

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