WASHINGTON – The government's healthcare fraud prevention and enforcement efforts recovered more than $4 billion in taxpayer dollars for the Medicare, Medicaid and Children's Health Insurance Program (CHIP) in 2010, the largest sum ever recovered in a single year, according to findings published in the government's Health Care Fraud and Abuse Control Program (HCFAC) report.
Department of Health and Human Services Secretary Kathleen Sebelius and U.S. Associate Attorney General Thomas J. Perrelli made the announcement Monday. They also announced new rules authorized by the Affordable Care Act that will further bolster the government's efforts to fight fraud, waste and abuse in those programs.
Sebelius and Perrelli attributed the success of the joint Department of Justice (DOJ) and HHS effort to the Health Care Fraud Prevention & Enforcement Action Team (HEAT), created in 2009. Information technology, data sharing and data analytics support the team's work.
"President Obama has made it very clear that fraud and abuse of taxpayers' dollars are unacceptable," said Sebelius. "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."
[One GOP Senator disagrees. See GOP puts heat on Obama's 'costly' Medicare fraud-fighting technology.]
"Our aggressive pursuit of healthcare fraud has resulted in the largest recovery of taxpayer dollars in the history of the Justice Department," said Perrelli. "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 healthcare programs."
2010 successes
HHS and DOJ have enhanced their coordination through HEAT and have expanded Medicare Fraud Strike Force teams since 2009.
In 2010, the total number of cities with Strike Force prosecution teams was increased to seven, all of which have teams of investigators and prosecutors dedicated to fighting fraud. The Strike Force teams use advanced data analysis techniques to identify high-billing levels in healthcare fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as healthcare providers or suppliers. Strike Force enforcement accomplishments in all seven cities during 2010 include:
- 140 indictments involving charges filed against 284 defendants who collectively billed the Medicare program more than $590 million;
- 217 guilty pleas negotiated and 19 jury trials litigated, winning guilty verdicts against 23 defendants; and
- Imprisonment for 146 defendants sentenced during the fiscal year, averaging more than 40 months of incarceration.
Including Strike Force matters, federal prosecutors opened 1,116 criminal healthcare fraud investigations as of the end of 2010, and filed criminal charges in 488 cases involving 931 defendants. A total of 726 defendants were convicted for health care fraud-related crimes during the year.
[One of the largest Medicare fraud sting occcurred in October 2010. See: IT aid to largest Medicare fraud sting in history.]
In addition to the criminal enforcement successes, 2010 was a record year for recoveries obtained in civil healthcare matters brought under the False Claims Act-more than $2.5 billion, which is the largest in the history of the Department of Justice.
