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Understanding Obamacare: Cracking Down on Fraud

Jan. 13, 2014
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Question: How does Obamacare combat fraud?

Answer: With health care representing 17% of our entire economy, we must be vigilant to ensure our money is being spent the right way. Luckily, the Affordable Care Act works tirelessly to reduce poor and fraudulent spending in the health care sector.

Thanks to the Affordable Care Act, unlawful pricing by pharmaceutical companies, Medicare fraud by hospitals, illegal marketing of medical devices and pharmaceuticals, and illegal kickbacks can be prevented like never before. For every dollar we spend on reducing health care fraud, the government recovers $7.90. Reducing fraud takes much of the fear out of health care, and it’s also a smart investment.

The Affordable Care Act provides new tools for combating fraudulent spending, including increased transparency between government transactions, greater oversight of insurance company abuses and rapidly correcting overpayments. These new transparency and accountability tools have helped the federal government remove 150,000 ineligible providers from Medicare’s billing system, and recovered $4.2 billion in 2012 alone.  

Another fraud-reducing component of Obamacare is the collaboration of the federal Department of Health and Human Services and the Department of Justice in the Health Care Fraud Prevention and Enforcement Action Team. This team cracks down on fraudulent organizations and individuals and returns the savings to the Medicare Trust Fund. False charges by providers now have new penalties, new tools make it easier to recover improper payments and the Department of Justice has more power to investigate wrongdoings in nursing homes and other facilities.

—Kevin Kane, lead organizer, Citizen Action of Wisconsin

The Shepherd Express and Citizen Action of Wisconsin will answer questions about the Affordable Care Act during its implementation. Got a question? Email editor@shepex.com.

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TAGS: Affordable Care Act, ACA, Obamacare, insurance, Kevin Kane, Citizen Action, health care, fraud, Medicare Trust Fund



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