Three companies hired to process Medicare bills and protect the system from fraud recently pled guilty to defrauding the program and agreed to settle for a total of $16 million, government officials told a House subcommittee.
In addition, two insurance company senior executives were found guilty of defrauding Medicare by knowingly submitting false information to HCFA.
At its last hearing, on July 14, the Subcommittee on Oversight and Investigations heard from the General Accounting Office how, since 1993, six Medicare contractors have been fined over $235 million for defrauding the program.
The contractors paid claims they shouldn't have paid, destroyed claims, failed to collect money from providers and falsified their performance results to HCFA officials.
According to the Department of Health and Human Services' Office of the Inspector General, New Mexico Blue Cross and Blue Shield concealed billing errors during an annual audit and blocked federal auditors from reviewing hospital-billing claims. The company agreed to a settlement of $5.86 million.
Blue Cross and Blue Shield of Colorado concealed, destroyed and falsified information HCFA uses to evaluate contractors' effectiveness. The company agreed to pay $6.84 million to settle its case.
A third company, Rocky Mountain Health Care Corp., jointly owned by the New Mexico and Colorado contractors, pled guilty to conspiring to obstruct a federal audit and agreed to pay a $500,000 fine.
The companies no longer work for Medicare.
The two executives, one from Blue Shield of Western New York and the other from Blue Shield of Eastern New York, reported to HCFA that some employees had worked on Medicare claims when, in fact, they hadn't. The two will be sentenced on Oct. 21.
