The Center for Medicare and Medicaid Services is taking a cue from the generous whistleblower rewards that have prompted the rapid growth of False Claims Act cases alleging health care fraud and an Internal Revenue Service program designed to motivate individuals to report tax fraud, which has collected almost $1.6 billion and paid about $193 million in rewards over a five-year period.
In a proposed rule issued April 24 and published in the April 29 Federal Register, CMS said it would dramatically overhaul its existing individual reward program (IRP) with an eye towards improving recoveries from Medicare fraud reported by individuals. Currently, CMS rewards a tipster with up to $1,000 if the tip results in a recovery. But this program, which was instituted in 1998, has paid less than $16,000 on 18 rewards over its 15-year life — hardly a drop in the bucket compared to the IRS program.
If the rule is finalized as proposed, CMS would pay 15% of the first $66 million recovered to a person who provides information about a specific individual engaging in specific activities during a specific time period. The reward could amount to as much as $9.9 million. By upping the potential reward, CMS hopes more people will monitor the claims submitted to Medicare and learn how to detect and report fraud.
What impact do you think this change in the IRP will have on fraud reporting? Will it have an impact on the number of FCA cases filed?
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