Federal Medicare fraud prevention at an all-time high

By Bernie Monegain
08:26 AM

HIT program recovers more than $4B in 2011

CHICAGO – Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder recently highlighted the Obama Administration's efforts to prevent Medicare fraud, through the Affordable Care Act and the Health Care Fraud Prevention and Enforcement Action Team (HEAT).

On April 4 in Chicago, the pair spoke at the seventh regional healthcare fraud prevention summit hosted by the Department of Justice and HHS.

The Obama Administration’s HEAT efforts have resulted in record-breaking healthcare fraud recoveries, Holder said. In fiscal year 2011, for the second year in a row, the departments’ anti-fraud activities resulted in more than $4 billion in recoveries, an all-time high.

“We have a simple message to criminals thinking about committing Medicare fraud: Don’t even try,” said Sebelius. “Thanks to health reform and our administration’s work, we have new tools and resources to catch criminals and stop Medicare fraud before it happens.”

“This administration continues to move aggressively in protecting patients and consumers and bringing health care fraud criminals to justice,” said Holder. “Through HEAT, we have achieved unprecedented, record-breaking successes in combating health care fraud and as a result of the Affordable Care Act, we have additional critical resources, tools and authorities to continue this great success.”

According to Sebelius, new tools provided by the Affordable Care Act are strengthening the Obama Administration’s efforts to fight healthcare fraud. As a result of Affordable Care Act provisions, criminals face tougher sentences for health care fraud; contractors that police the Medicare program for waste, fraud and abuse are expanding their programs; government entities, including states, the Centers for Medicare and Medicaid Services (CMS), and law enforcement partners at the Office of the Inspector General (OIG) and DOJ, have greater abilities to work together and share.

Increased collaboration has yielded significant results through the HEAT partnership, officials say. Since the creation of HEAT in 2009, the Medicare Fraud Strike Force operations have expanded from two to nine locations throughout the United States, including Chicago. Strike Force operations expanded to Chicago in February 2011 and since that time, charges have been filed against more than 35 defendants in the Northern District of Illinois for offenses related to healthcare fraud. Overall, in fiscal year 2011, strike force operations in nine locations charged a total of more than 320 defendants for allegedly billing more than $1 billion in false claims.

In February, as a result of HEAT and strike force actions, a Dallas-area physician and the office manager of his medical practice, along with five owners of home health agencies, were arrested on charges related to their alleged participation in a nearly $375 million health care scheme involving fraudulent claims for home health services. In conjunction with this action, CMS imposed payment suspensions against 78 home health agencies in the Dallas area.