$4 Billion Recovered In Fraud Prevention And Enforcement Drive, USA

Editor's Choice
Main Category: Medicare / Medicaid / SCHIP
Also Included In: Transplants / Organ Donations;  Health Insurance / Medical Insurance
Article Date: 27 Jan 2011 - 10:00 PDT

email to a friend   printer friendly   opinions  

The US Department of Health and Human Services together with the Department of Justice have managed to claw back a record $4 billion in one year in the government's health care fraud prevention efforts. HHS Secretary Kathleen Sebelius and US Associate Attorney General, Thomas J. Pirelli said this is by far the largest amount ever recovered from individuals who tried to defraud the elderly and the taxpayer.

The HHS added that the new Affordable Care Act rules will help the department function proactively in the prevention of fraud, abuse and waste in Medicare, Medicaid and CHIP (Children's Health Insurance Program).

The Health Department believes that these results are due in a significant part to President Obama's focus on eradicating waste, fraud and abuse. It goes on to say that this achievement could not have taken place without the Health Care Fraud Prevention & Enforcement Action Team, which was set up in 2009.

Sebelius said that this is just the beginning, and that the Affordable Care Act allows for new tools and resources to combat fraud more effectively. Sebelius said:

"President Obama has made it very clear that fraud and abuse of taxpayers' dollars are unacceptable. And for too long, our fraud prevention efforts have focused on chasing after taxpayer dollars after they have already been paid out. Thanks to the President's leadership and the new tools provided by the Affordable Care Act, we can focus on stopping fraud before it happens."

Perrelli said:

"Our aggressive pursuit of health care fraud has resulted in the largest recovery of taxpayer dollars in the history of the Justice Department. These actions are in large part because of the great work being led by the Health Care Fraud Prevention and Enforcement Action Team. Through this initiative, we are working in partnership with government, law enforcement and industry leaders, and the public to protect taxpayer dollars, control health care costs, and ensure the strength and integrity of our most essential health care programs."

The $4 billion has been returned to the Medicare Health Insurance Trust Fund, the Treasury and some other government offices.

In a communiqué, the HHS wrote:

"This is an unprecedented achievement for the Health Care Fraud and Abuse Control Program (HCFAC), a joint effort of the two departments to coordinate federal, state, and local law enforcement activities to fight health care fraud and abuse."

The Affordable Care Act makes provision for an additional $350 million for HCFAC activities. Authorized tools are already in use, including newer enrollment requirements, enhanced screenings, better data sharing across government departments, expanded overpayment recovery efforts, and more effective supervision of private insurance abuses.

The DOJ and HHS have liaised closely through HEAT and have enhanced Medicare Fraud Strike Force teams over the last two years. A series of regional fraud prevention summits were held around the country by both government departments, letters have been sent to state attorneys general requesting that they work with HHS, while law enforcement officials at local, state and federal levels have been urged to mount a considerable outreach campaign to help seniors and other Medicare beneficiaries steer clear of fraud and scams.

By the end of 2010 there were seven Strike Force prosecution teams, consisting of investigators and prosecutors focused on combating fraud. They use state-of-the-art equipment and techniques to spot levels of high billing in fraud hot spots, making it easier for interagency teams to home in on likely and chronic fraudsters.

In 2010, the accomplishments of the Strike Force enforcement include:

• 140 indictments with charges against 284 individuals. They had collectively billed the Medicare program in excess of $590 million
• 217 guilty pleas and 19 jury trials litigated. Guilty verdicts were won against 23 defendants
• 146 defendants were sentence to custodial sentences (prison) of 40 months (average)

As of the end of financial year 2010, federal prosecutors (including Strike Force matters) opened 1,116 criminal health care fraud investigations and filed 488 criminal charges involving 931 defendants. 726 defendants were found guilty of health care fraud-related crimes during that financial year.

The HHS added:

"In addition to these criminal enforcement successes, 2010 was a record year for recoveries obtained in civil health care matters brought under the False Claims Act - more than $2.5 billion, which is the largest in the history of the Department of Justice."

"HCFAC Annual Report" (HSS)

"Stop Medicare Fraud" (HSS)

Source: HHS

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

• Additional
• References
• Citations