Preventing/Punishing Healthcare Fraud
Published on May 12, 2015 By Daiwa In Politics

Just seems like something people would enjoy knowing.  Physicians are currently subject to the scrutiny of the following fraud-prevention agencies & programs (could be more for all I know):


HEAT  -  Healthcare Fraud Prevention and Enforcement Action Team

CERT  -  Comprehensive Error Rate Testing

MACs  -  Medicare Administrative Contractors

MEDICs  - Medicare Drug Integrity Contractors

RACs  - Recovery Audit Program Contractors

ZPICs  - Zone Program Integrity Contractors


Those apparently being insufficient for the task at hand, in 2010 CMS launched FPS, the Fraud Prevention System, a predictive analytics technology running algorithms on all Medicare claims prior to payment.

But they weren't done.  Apparently anticipating armed resistance to all this fraud prevention, in 2012 CMS created the Program Integrity Command Center (PICC), bringing together investigators from Medicare, Medicaid and the law enforcement community to develop analytics that identify fraud and mobilize a rapid response.

I can tell you that RACs are the most brutal and painful and that MEDICs will be of no help once the inevitably-soon-to-be-constituted PICC SWAT Team arrives.

on May 12, 2015

They had to have some reason for all those ammo purchases, after all.