U.S. GAO - Medicare and Medicaid Fraud, Waste, and Abuse: Effective Implementation of Recent Laws and Agency Actions Could Help Reduce Improper Payments

GAO Report-11-409T March 9, 2011
Highlights Page (PDF) Full Report (PDF, 31 pages) Accessible Text

GAO has designated Medicare and Medicaid as high-risk programs because they are particularly vulnerable to fraud, waste, abuse, and improper payments (payments that should not have been made or were made in an incorrect amount). Medicare is considered high-risk in part because of its complexity and susceptibility to improper payments, and Medicaid because of concerns about the adequacy of its fiscal oversight to prevent inappropriate spending. In fiscal year 2010, the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare and Medicaid--estimated that these programs made a total of over $70 billion in improper payments. This statement focuses on how implementing prior GAO recommendations and recent laws, as well as other agency actions, could help CMS carry out five key strategies GAO identified in previous reports to help reduce fraud, waste, and abuse and improper payments in Medicare and Medicaid. It is based on 16 GAO products issued from April 2004 through June 2010 using a variety of methodologies, such as analyses of Medicare or Medicaid claims, review of relevant policies and procedures, and interviews with officials. In February 2011, GAO also received updated information from CMS on agency actions.

The amount of improper payments creates urgency for CMS to effectively implement prior GAO recommendations, provisions in recently enacted laws, and recent guidance related to five key strategies to help reduce fraud, waste, abuse, and improper payments in Medicare and Medicaid. 1. Strengthening provider enrollment standards and procedures. Strengthening the standards and procedures for provider enrollment can help reduce the risk of enrolling entities intent on defrauding the program. The Patient Protection and Affordable Care Act as amended (PPACA) strengthens aspects of provider enrollment in Medicare and Medicaid. CMS is implementing these provisions, which include designating providers by levels of risk and providing more stringent review of high-risk providers. 2. Improving prepayment review of claims. Prepayment reviews of claims help ensure that Medicare pays correctly the first time. CMS is implementing a PPACA provision requiring states to add automated prepayment controls in their Medicaid programs. In addition, CMS is seeking contractors to apply predictive modeling analysis to claims as a way to develop new prepayment controls to add to Medicare; however, CMS has not implemented certain GAO recommendations related to prepayment review. 3. Focusing postpayment claims review on most vulnerable areas. Postpayment reviews are critical to identifying payment errors and recouping overpayments. CMS is instituting recovery audit contractor (RAC) programs in Medicare and Medicaid to increase postpayment review. However, CMS contractors generally choose their focus for claims review, and GAO continues to contend that CMS should make it a priority to focus claims administration contractors' postpayment review on the most vulnerable areas. 4. Improving oversight of contractors. CMS's oversight of contractors' activities to address fraud, waste, and abuse is critical. CMS has taken action to address GAO recommendations to improve oversight of prescription drug plan sponsors' fraud and abuse programs and to comply with other contractor oversight provisions in PPACA. 5. Developing a robust process for addressing identified vulnerabilities. Having mechanisms in place to resolve vulnerabilities that lead to improper payment is critical, but CMS has not developed a robust corrective action process for vulnerabilities identified by Medicare RACs, and has not fully implemented GAO recommendations to improve it. Further, CMS's guidance to states on Medicaid RAC programs did not include steps to address vulnerabilities through a corrective action process. Effective implementation of these recommendations, provisions of law, and guidance will be a key factor in helping to reduce future improper payments.


U.S. GAO - Medicare and Medicaid Fraud, Waste, and Abuse: Effective Implementation of Recent Laws and Agency Actions Could Help Reduce Improper Payments

Congress Delves into Medicare Fraud

AoA March eNewsletter

The latest edition of the AoA eNewsletter is posted online. Below is the Table of Contents.  You can read the March eNews in its entirety by clicking on:  http://www.aoa.gov/AoARoot/Press_Room/Enews/index.aspx.

While you are there, please check out AoA’s new website (www.aoa.gov) – tell us what you think! After reviewing our website please scroll down to the Feedback Section at the bottom of the home page to leave your comments.

Table of Contents

AoA News

    Older Americans Month 2011 Materials Now Available
               
    Profile of Older Americans: 2010 Now Available
               
    AoA’s March Widget Highlights AoA’s Nutrition Program
               
    SMP Recent Events and Upcoming Activities
               
Other HHS News
   
    Webinar on Healthy Eating Advice:  The New Dietary Guidelines for
    Americans, 2010
               
    HHS and DOJ to Convene Fraud Prevention Summit in Detroit
               
    New Report Details Affordable Care Act Resources and Flexibility for
    States
               
    New NIH Cookbook Encourages Families to Eat Healthfully
               
    Medicare Part D Benefit Update
               
Funding Opportunity
   
    AoA and NIA Joint Initiative to Improve the Health and Well-Being of Older
    Americans by Translating Research into Practice
               
More News
   
    FinCEN Advisory Warns of Elder Financial Exploitation
   
    USCIS Expands Outreach to the Aging Network for Help in Dissemination of
    Information
               
    KCMU Release New Resources on Medicaid Long-Term Services and Supports
   
    Free Webinar to Help Nursing Homes Prepare to be Clinical Placement Sites
    for Nursing Students
               
    National Observances

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Health Business Blog » Since When Is a Co-pay The Cure For Fraud?

by David E. Williams

Medicare coverage for home care visits has a checkered history. The original rationale for including home care in Medicare was straightforward and compelling: it’s much cheaper, healthier and pleasant for a patient to be at home receiving skilled care than to stay in a hospital for lack of enough support in the home environment. That logic remains solid. Unfortunately it doesn’t mean Medicare spending has dropped with home care coverage in place. That’s because operators of home care agencies don’t see it as their job to reduce Medicare spending and neither do hospitals. Both want to make as much money as possible under the fee-for-service system. Home care ended up being an additional cost to the system, not a cheaper substitute for the hospital.

There have been various attempts to control home care spending. The latest is a 13-1 recommendation by the Medicare Payment Advisory Commission to impose co-payments to discourage unneeded use of home care services.
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H.R. 173: To amend titles XI and XVIII of the Social Security Act to provide increased civil and criminal... (GovTrack.us)

To amend titles XI and XVIII of the Social Security Act to provide increased civil and criminal penalties for acts involving fraud and abuse under the Medicare Program and to increase the amount of the surety bond required for suppliers of durable medical equipment.

Sponsor:	Rep. Clifford Stearns [R-FL6](no cosponsors) Cosponsors:
Text:	The text of this legislation is not yet available on GovTrack. It may not have been made available by the Government Printing Office yet.
Status:	Introduced Jan 5, 2011 Referred to Committee View Committee Assignments Reported by Committee ... House Vote ... Senate Vote ... Signed by President ... This bill is in the first step in the legislative process. Introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee. [Last Updated: Jan 6, 2011 11:33AM]
Last Action:	Jan 5, 2011: Referred to House Energy and Commerce

Current Status

Granny and Clyde: When Seniors Scam Seniors - WSJ.com

Image by epSos.de via FlickrBy JASON ZWEIG and MARY PILON

A grim category of crime is on the rise: senior-on-senior financial fraud.

According to regulators and prosecutors, there has been a significant increase recently in the number of cases in which older investors have been taken advantage of by elderly scam artists.

"That's a definite new trend," says Denise Voigt Crawford, the Texas securities commissioner. "We're seeing more cases of older people ripping off other older people. Someone joked that seniors ripping off their peers is becoming 'the new retirement plan.'"

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Feds Charge 94 Docs, Others With Medicare Fraud from MedPage Today

By John Gever, Senior Editor, MedPage Today

Charges have been unsealed against 94 physicians, healthcare and billing company executives, and others in five cities across the country, alleging that they submitted a total of $251 million in false Medicare claims.

U.S. Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced the indictments at a meeting on Medicare fraud in Miami, calling it "the largest federal healthcare fraud takedown since the Medicare Fraud Strike Force operations began in 2007."
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NEJM -- Geographic Variation in Medicare Spending

Editorial by Arnold M. Epstein, MD
 
In my third and fourth years of medical school at Duke University, I was totally engaged in learning clinical strategies and algorithms: when to admit a patient with chest pain from the emergency ward, when and how to work up dyspepsia, when to schedule laboratory work and ambulatory follow-up for stable hypertension. These protocols are the nuts and bolts of day-to-day practice. I learned them as an apprentice, trailing fellows and attending physicians on ward rounds and in the clinic, since the level of detail needed to guide these decisions never seemed to be in the scientific literature. After finishing medical school, I moved to Boston for house-staff training. To my great surprise, I encountered a whole new set of protocols for exactly the same conditions. Their proponents espoused them with equal vigor and certainty as my mentors at Duke, yet the strategies were often substantially different. It was then that I realized the scary truth: the science behind medicine is sorely lacking, and often there is no clearly right answer.


Nearly 40 years ago, Wennberg published his seminal work showing variation, by a factor of two or more, in the rates of common surgical procedures such as tonsillectomy and cholecystectomy across small geographic areas in Vermont, areas that had no apparent differences among their populations of patients.¹ In subsequent years, Wennberg, Fisher, and their colleagues at Dartmouth have used administrative data and information from surveys² to show that regional variation is a national phenomenon that persists despite adjustment for differences in the case mix and that greater use of medical services is not associated with higher quality or better outcomes. In fact, the Dartmouth findings suggest just the opposite and are touted as evidence of great waste. Yet critics persist, worrying about the shortcomings of administrative data.


The article by Zuckerman and colleagues in this issue of the Journal³ both supports and modifies the Dartmouth gospel. The authors used Medicare claims data linked to survey data on health status from the Medicare Current Beneficiary Survey to examine spending in Hospital-Referral Regions (HRRs) nationwide. The claims data alone allowed them to recapitulate the Dartmouth findings, showing large geographic variation in expenditures for medical services: a 52% difference in per-beneficiary expenses between the top-spending and bottom-spending quintiles of HRRs. However, sequential controls for demographic characteristics and survey information about baseline health status, subsequent changes in health status, and newly or previously diagnosed illness reduced the difference in expenditures between the top and bottom quintiles to 33%. Because finer categories of risk-adjustment data regarding the health of beneficiaries were used in this study than in previous studies, they explained a greater proportion of the variation in spending. However, much as was found in Dartmouth work,² substantial regional variation in Medicare spending remained.

..........
Of course, we should anticipate some variation across geographic regions. With the constant flow of new technology and drugs and the ever-changing scientific literature, it would be unreasonable to expect complete consensus or equal rates of diffusion of new clinical practice across regions. Without adjustment, the difference in spending between the quintiles of highest spending and lowest spending was more than 50%, according to Zuckerman and colleagues. That degree of variation, with no apparent difference in outcomes, raises questions of unacceptable inefficiency in the high-spending areas or even of impropriety. In contrast, if the true variation in spending is only 33%, does it still matter? I think yes. Changing the patterns of use of medical resources in the higher-spending areas to resemble more closely the patterns in the lowest-spending areas would save an enormous amount of money. Moreover, unwarranted variation reminds us that in too many areas of medicine, we lack knowledge of what works best and far too often fail to follow consistently what we know to be superior practice.


If regional variation could elucidate specific medical services that should be targeted as unnecessary or overused, we would merely study patterns of care in high-use areas. Unfortunately, past studies of services such as surgical procedures indicate that high- and low-use areas have similar proportions of inappropriate care.^5,6 Instead, most of the discrepancy appears attributable to discretionary decisions by physicians — decisions (such as whether we ask stable patients with hypertension to return for a routine check in 2, or 4, or 6 months) that lack consensus about the correct answer.⁷

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The ACA’s New Weapons against Health Care Fraud | Health Care Reform Center

by John K. Iglehart in the New England Journal of Medicine

Marshaling expanded financial resources, aggressive new legal authority, and rare bipartisan solidarity, the Obama administration is accelerating federal efforts to fight health care fraud, waste, and abuse that cost taxpayers and private insurers billions of dollars every year. Although the new forms of authority are granted by the Affordable Care Act (ACA), which Republicans unanimously opposed, most GOP legislators strongly support — and some even sponsored measures to enable¹ — the more rigorous crackdown on illegal activities that plague Medicare, Medicaid, and private insurers. Under past policies, Congress and the executive branch “way, way, way” underspent on fighting health care fraud, according to Kerry Weems, who was acting administrator of the Centers for Medicare and Medicaid Services (CMS) from 2007 to 2009.²
 
Since 1990, the Government Accountability Office (GAO) has designated Medicare as a high-risk federal program because its vast size and complexity make it vulnerable to fraud, waste, and abuse. In 2009, government-wide “improper payments” totaled $98 billion — more than half of it paid by Medicare and Medicaid. It is uncertain how much of the activity that resulted in these payments was actual fraud, but Lewis Morris, chief counsel of the Office of Inspector General (OIG), Department of Health and Human Services (DHHS), told the Senate Finance Committee last year, “Although we cannot measure the full extent of health care fraud in Medicare and Medicaid, everywhere we look we continue to find fraud in these programs.” The National Health Care Antifraud Association, an organization of some 100 private insurers and public agencies, estimates conservatively that $60 billion of total national health care spending each year is accounted for by fraud.

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• REP. DARRELL ISSA: The Lackluster Record of Government Health Care: Already Medicare, which acc... (pajamasmedia.com)

HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder Send Letter to State Attorneys General On New Outreach and Education Efforts to Combat Medicare Fraud

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WASHINGTON - U.S. Secretary of Health and Human Services Kathleen Sebelius and Attorney General of the United States Eric Holder sent a letter to state attorneys general urging them to work with HHS and federal, state, and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries about how to prevent scams and fraud beginning this summer. The outreach campaign is another step in the ongoing work of the Health Care Fraud Prevention Enforcement Action Team (HEAT), a cabinet-level initiative launch by HHS and DOJ in May 2009.

“We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors – and we are seeking your help to stop it,” said Secretary Sebelius and Attorney General Holder in the letter. “Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud.”

In the letter, the Secretary and Attorney General outline education and outreach efforts where state attorneys general could make a big difference. These include efforts to cut the improper payment rate, which tracks fraud, waste and abuse in the Medicare Fee for Service program, in half by 2012; a series of regional fraud prevention summits around the country over the next few months; regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud effort; HHS’s plans to double the size of the Senior Medicare Patrol and to put more boots on the ground in the fight against Medicare fraud; and a new educational media campaign this summer to educate Medicare beneficiaries about how to protect themselves against fraud.

Health Reform Seeks To Protect Medicare Consumers from Fraud

In order to assure Medicare consumers’ access to new benefits, the Department of Health and Human Services (HHS) is implementing several key fraud prevention measures included in the new health are reform law. In a June 2 webcast, Secretary Sebelius detailed a number of actions HHS and the Department of Justice (DOJ) have taken to prevent Medicare fraud. HHS and DOJ will continue to collaborate on existing fraud prevention programs, such as the Senior Medicare Patrol program (SMP) and the South Florida fraud hotline, which engages consumers in fraud detection and reporting. New efforts to prevent fraud that are part of the health care reform law include steeper penalties for those who violate Medicare rules and improved oversight. For example, HHS hopes to be able to perform comprehensive data analyses to predict and protect against Medicare fraud.
Webcast panelists stressed a number of precautions that consumers and caregivers can take in order to help protect against fraudulent Medicare practices:

• Be aware: Anyone can be a victim of Medicare fraud
• Consumers should guard their identity closely: Call 1-800-MEDICARE to report suspicious behavior
• Do not give out personal information over the phone or internet: If you do not recognize the organization or person asking for your information, do not give information to them. Always ask questions about who they are and why they need your information. 
• Know that guaranteed Medicare benefits are the same and consumers do not have to do anything in order to continue receiving them.

Watch the webinar on preventing fraud, waste and abuse in Medicare.

Read about new efforts to fight Medicare fraud in health reform.

Bad Investment Advice Can Turn a Free Meal Costly - NYTimes.com

By MILT FREUDENHEIM

While the advisers deny misleading the Johnsons, Mrs. Johnson said she and her husband were not in a position to make well-informed decisions.

“We were frugal but not very smart about money,” she said. “We didn’t have the right knowledge to ask the right questions.”

The Johnsons, who were living on his retirement, lost most of their money. They were hardly alone.

“Financial fraud is the No. 1 consumer protection issue for AARP,” said Andres Castillo, who heads an AARP program that monitors free lunch seminars and similar presentations. In an AARP survey last year of people 55 and older, 9 percent said they had attended a free financial seminar within the last three years. That translates into approximately 5.9 million people, the group said.

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Investors Recruit Terminally Ill to Outwit Insurers on Annuities - WSJ.com

By MARK MAREMONT And LESLIE SCISM

"Terminal Illness? $2,000 in CASH, Immediately Available."

That was the promise of an advertisement that appeared regularly in 2007 and 2008 in the Rhode Island Catholic, the official newspaper of the local diocese. The money, the ad said, was coming from a "compassionate organization" that wanted to provide "financial assistance" for those near death.

In reality, the ad was a recruiting pitch for a plan hatched by a prominent Rhode Island estate-planning lawyer, who believed he had discovered a way to use an investment product sold by insurance companies to make no-risk bets on the stock market. He recruited dozens of terminally ill people to, in effect, serve as paid fronts for purchases of the product, variable annuities. The lawyer and other investors put tens of millions of dollars into the policies, hoping to reap a profit when the recruits died.

The arrangement, now under investigation by federal prosecutors and snarled in litigation, is the latest twist in a cat-and-mouse game between insurers and sophisticated investors. The investors comb through policies marketed to individuals and figure out ways to convert them into profit-making products for people with no emotional bond to the deceased.
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Medicare Patrol volunteers help seniors avert scams

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from Sioux City Journal

Connie Malloy may not look like a vigilante, but when it comes to Medicare fraud, that's exactly what the 83-year-old Sioux City woman has become.

A member of the Senior Medicare Patrol since its 1997 inception, Malloy is one of more than 4,700 volunteers, nationwide, educating seniors on how not to be scammed when it comes to health care.

Senior citizen volunteers like Malloy serve as the government's eyes and ears when it comes to eliminating such fraud, saving taxpayers more than $100 million in the process, according to Iowa Senior Medicare Patrol's website.

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Pharmaceutical Industry News from the Wall Street Journal

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Pfizer CEO Cites Public’s ‘Legitimate Anger’ at Corporations
Speaking to a roomful of CEOs in Boston yesterday, Jeff Kindler said corporations must face the “real and legitimate anger” of the public and regain lost trust, according to the Connecticut newspaper the Day. “When the majority don’t trust you, they will find a way to force you to change,” he said.

Merck To Supremes: Investors Should Have Sued Us Sooner
Here’s what a lawyer for Merck told the Supreme Court yesterday:

… there was abundant information in the public domain as of 2001 at least suggesting the possibility that [Merck] had engaged in securities fraud.

The company is taking that somewhat surprising position to bolster its case in investor lawsuits that allege the company downplayed the safety risks of Vioxx. Specifically, Merck has argued that investors waited too long to file the suits. (Investors have two years to sue from the time they should have suspected fraud.) So the lawyers on both sides are arguing over when investors had enough information to file a lawsuit.

By the way, besides arguing that investors should have sued sooner, Merck is also arguing that there isn’t enough evidence for investors to make a case against the company, the WSJ notes.

How a Decades-Old Drug Is Still a Patented Blockbuster
Abbott isn’t likely to face generic competition on its cholesterol drug TriCor until at least March, 2011, according to an SEC filing the company put out yesterday. Filings like this come out all the time, but this one is particularly striking because the key compound in TriCor, generically known as fenofibrate, was discovered in the 1960s and hit the market in Europe in 1975. Drugs that old are almost always generic.

Sen. Specter Introductry Comments on S 1843 - Healthcare Fraud

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Sen. Arlen Specter [D-PA]: [Introducing S. 1843] Mr. President, I have sought recognition to speak about the Strengthening Enforcement for Health Care Fraud Crimes Act of 2009, which I am introducing today with Senator Graham.

At a time when Congress is poised to pass historic health care reform legislation to protect the health of Americans, it is imperative that we do all that we can to eliminate waste, fraud and abuse in America's health care systems. We must do all that we can to prevent, detect and vigorously prosecute health care fraud.

Health care fraud costs tax payers billions of dollars each year. National health care spending in the United States exceeded $2.2 trillion and represented 16 percent of the Nation's Gross Domestic Product in 2007. The National Health Care Anti-Fraud Association, NHCAA, conservatively estimates that 3 percent of all health care spending--or more than $60 billion--is lost to health care fraud perpetrated against both public and private health plans. Other estimates by government and law enforcement agencies suggest losses from fraud as high as 10 percent--or $220 billion annually.

Fraud committed against both public and private plans by health care providers, medical equipment suppliers, drug companies, and also by fraudulent plan operators and brokers, undermines public trust in our health care system.

More importantly, the costs of health care fraud are borne by all Americans. It does not matter if you have health insurance sponsored by your employer, if you purchase privately your own insurance policy, or pay taxes to fund government health care programs. Health care fraud results in reduced benefits and coverage, and higher premiums and costs. It can mean higher taxes and increased budgetary challenges.

Health care fraud often targets the most vulnerable in our society--the elderly, the poor, and the infirm. Criminals involved in health care fraud falsify patients' medical records and steal patients' personal and insurance information to submit fraudulent claims. Health care fraud subjects patients to unnecessary and dangerous medical procedures. According to the FBI:

One of the most significant trends observed in recent health care fraud cases includes the willingness of medical professionals to risk patient harm in their schemes. FBI investigations in several offices are focusing on subjects who conduct unnecessary surgeries, prescribe dangerous drugs without medical necessity, and engage in abusive or sub-standard care practices.

FBI Financial Crimes Report to the Public, Fiscal year 2007.

Criminologists have long reported that criminals look at three factors in performing their own cost benefit analysis: the risk of getting caught; the probability of being convicted; and the severity of the punishment.

The bill I am introducing today addresses the third factor--and sends the message loud and clear to those who would contemplate committing health care fraud. If caught stealing $100,000 or more you will go to jail--no ifs, ands or buts. The bill provides a sentence of at least 6 months incarceration for committing health care fraud with losses of $100,000 or more. You may even get more jail--under the discretionary guidelines--but no one will get less than 6 months for schemes of this size.

Since the Supreme Court decided United States v. Booker in January 2005 and made the Sentencing Guidelines advisory, sentencing judges have wide discretion to impose sentences on criminal defendants unless mandatory minimum sentences are applicable. Except for aggravated identity theft crimes, defendants do not face mandatory imprisonment for white collar crimes. Given the importance and necessity to vigorously prosecute and punish serious health care fraud crimes, I urge the Senate to pass this bill. Without it, there will be no certainty of punishment nor effective deterrence for serious health care fraud crimes.

S. 1843: A bill to provide increased penalties for health care fraud (GovTrack.us)

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Sponsor: Sen. Arlen Specter [D-PA]
Cosponsors: Lindsey Graham [R-SC]

Text

Status:
Introduced Oct 22, 2009
Referred to Committee on Judiciary

Updated Information

DHHS OIG FY2010 Work Plan

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This publication describes activities that OIG plans to initiate or continue with respect to the programs and operations of the Department of Health and Human Services (HHS) in the next year.

In this Work Plan, the ongoing and planned reviews are grouped into two major parts:

• “Centers for Medicare & Medicaid Services” (CMS) describes reviews related to Medicare, Medicaid, information systems controls, the Childrens Health Insurance Program, and related investigations and legal counsel to OIG.

• “Public Health and Human Services Programs and Departmentwide Issues” describes reviews related to agencies such as the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), the Administration on Aging (AoA), and the Administration for Children and Families (ACF). This part also describes departmentwide issues, such as financial accounting and information systems management.

Our planned reviews related to the American Recovery and Reinvestment Act of 2009 (Recovery Act) are provided in Appendix A of this document.

Read/Download Work Plan

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The Associated Press: Mafia, violent criminals turn to Medicare fraud

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By KELLI KENNEDY (AP)

Lured by easier money and shorter prison sentences, Mafia figures and other violent criminals are increasingly moving into Medicare fraud and spilling blood over what was once a white-collar crime.

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AMNews: Oct. 5, 2009. CMS probes Humana's lobbying tactics on reform ... American Medical News

A federal inquiry at the behest of a key Democratic lawmaker into an insurance company's attempt to influence the health system reform debate has prompted a groundswell of criticism from GOP leaders, who likened the government's actions to a "gag order" on reform critics.
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