Department Of Justice, HHS Boosts Number Of Investigators, Prosecutors Looking At Medicare, Medicaid Fraud

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Litigation / Medical Malpractice
Article Date: 22 May 2009 - 6:00 PDT

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HHS and the Department of Justice on Wednesday launched the Health Care Fraud Prevention and Enforcement Action Team to detect and prevent fraud in Medicare and Medicaid, the Washington Post reports (Johnson, Washington Post, 5/21). DOJ also plans to establish teams to address fraud in the Medicare Part D program and CHIP (Kennedy, AP/Houston Chronicle, 5/20). Wednesday's announcement also included a recommendation by President Obama's administration to include $311 million in the fiscal year 2010 budget to address health care fraud, which is a 50% increase from FY 2009. According to Attorney General Eric Holder, efforts to combat health care fraud will contribute to the administration's health care overhaul plans (Clark/Weaver, McClatchy/Kansas City Star, 5/20).

The task force, which will include HHS and DOJ staff members, law enforcement agents and prosecutors, will meet biweekly, CQ HealthBeat reports (Norman, CQ HealthBeat, 5/20). Under the plan, existing enforcement teams in Miami and Los Angeles will be expanded and new teams will be established in Houston and Detroit, where officials say suspicious billing patterns have emerged. In addition, the plan will set up task forces in 10 other major cities, which were not named (AP/Houston Chronicle, 5/20). The enforcement teams will increase site visits to durable medical equipment suppliers upon their enrollment. In addition, officials will expand training to help providers identify and prevent fraud or other mistakes (CQ HealthBeat, 5/20). The task force will use electronic claims data to detect "unusual billing problems," according to the Post (Washington Post, 5/21). HHS Secretary Kathleen Sebelius said the task force also intends to simplify billing systems and assist state officials in conducting Medicaid audits (CQ HealthBeat, 5/20). According to Holder, the joint task force will allow officials to share real-time intelligence data on health care fraud by monitoring claims payments, billing patterns and targeted surveillance (AP/Houston Chronicle, 5/20).

Money
According to the Miami Herald, health care fraud costs U.S. taxpayers at least $60 billion annually (Clark/Weaver, Miami Herald, 5/20). In the past, the largest sums recovered by the federal government have resulted from DOJ interventions in lawsuits against pharmaceutical companies filed under the False Claims Act. According to attorneys involved with the cases, such settlements are likely to reach record highs in FY 2009 (Washington Post, 5/21). In southern Florida, a task force created in 2007 helped convict 146 defendants and generated $186 million in fines and penalties. In addition, a Los Angeles team established in 2008 charged 37 defendants and generated $55 million for Medicare (CQ HealthBeat, 5/20).

Tony West, head of DOJ's Civil Division, said, "There is an incredible amount of money that can be recovered and returned to the health care trust fund, and that has a real impact" (Washington Post, 5/21). Sebelius said, "For every dollar we invest in fraud prevention and oversight, at least $1.55 comes back for the taxpayer" (CQ HealthBeat, 5/20). West added that health care has the "biggest single impact on the budget," and that pursuing health care fraud cases and recouping losses are "consistent with the president's agenda on health care reform" (Washington Post, 5/21).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation.

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