Federal officials have blocked or clawed back more than $1.6 billion in potentially improper Medicare laboratory payments since President Donald Trump returned to office, including $732 million tied to 157 lab providers booted from the program for alleged fraud. The Centers for Medicare and Medicaid Services (CMS) said the labs were suspected of billing Medicare for tests that were never performed, tests patients did not need and services billed at higher rates than they should have been. "When laboratories bill Medicare for tests they never performed, it drains the Medicare Trust Fund and diverts resources away from beneficiaries who need them," CMS Administrator Dr.
DOJ CHARGES 19 DEFENDANTS IN ALLEGED $4M PHILADELPHIA MEDICARE AND MEDICAID FRAUD In one case, the owner of a consulting company enrolled 14 labs in Medicare and billed the program more than $24 million, even though CMS said none of the labs appeared to be operating. CMS has since held back $12 million in payments to the labs and recovered another $7 million. Eleven of the 14 labs have been removed from Medicare, while the remaining three are still under investigation.
CMS said it is using artificial intelligence and other technology to sift through Medicare claims and spot unusual billing that could be a sign of fraud. The technology looks for billing that falls outside normal patterns and can flag suspicious claims for closer scrutiny. CMS can then hold, reject or deny a claim before Medicare pays it.
Of the $1.6 billion cited by the agency, more than $500 million in suspected fraudulent payments were stopped through 185 payment suspensions after CMS investigated 600 labs. "The previous administration treated our taxpayer-funded programs as piggy banks for fraudsters," the White House told Fox News Digital. "That is no longer the case, thanks to President Donald Trump, Vice President JD Vance, and Dr.
Oz, who is an anti-fraud superstar." TREASURY HAILS SUCCESS OF ANTI-FRAUD PROCESS THAT FLAGGED AND PREVENTED $99 MILLION IN PAYMENTS TO DEAD PEOPLE The agency also recovered more than $276 million in overpayments made to 442 suspect labs and said another $127 million in potentially fraudulent payments was prevented after 85 cases were referred to law enforcement. CMS pointed to two recent cases in Texas as examples of labs suspected of billing Medicare for services they did not provide. One lab began billing Medicare in late February.
CMS said it caught the suspicious activity early and denied $1.2 million in claims. The lab then changed the way it billed Medicare in early April in an apparent attempt to get around the agency’s safeguards, according to CMS. Officials continued watching its claims and stopped more than $150,000 in additional payments before removing the provider from Medicare later that month.
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