Healthcare reform to build on fight against Medicare fraud

By Bernie Monegain
07:06 AM

The Affordable Care Act offers effective new technology and sophisticated data analysis for reducing healthcare fraud that will build on programs that helped Medicare and Medicaid recover billions of dollars in 2009, according to the government's annual Health Care Fraud and Abuse Control Program (HCFAC) report.

Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder, released the report Thursday. They said the healthcare reform law would build on the success of existing fraud fighting efforts such as the HEAT Task Force.

The report showed that in fiscal year 2009, anti-fraud efforts resulted in $2.51 billion being deposited to the Medicare Trust Fund, a $569 million, or 29 percent, increase over 2008.  In addition, more than  $441 million in federal Medicaid money was returned to the Treasury, a 28 percent increase from 2008.

DOJ and HHS officials stressed that the expanded law enforcement efforts would be supported by the newly established Center for Program Integrity at the Centers for Medicare & Medicaid Services, which will use state-of-the-art methods to implement provisions of the Affordable Care Act that detect fraud and prevent improper payments. The Center will also work with the private health care sector to better target fraud and abuse.

"The Affordable Care Act gives us new tools to fight fraud, protect consumers, and safeguard taxpayer dollars," said Sebelius.  "It strengthens our ability to stop fraud before it starts by making it harder to submit false claims and easier to catch those who try to cheat out consumers.  And, the new law will guarantee that those who try to game the system face severe consequences."

"Our departments have a long history of working together in the fight against healthcare fraud," said Holder. "Today's report shows the success of our collaborative efforts to prevent, identify and prosecute the most egregious instances of healthcare fraud. We know that as long as healthcare fraud pays and goes unpunished, our healthcare system will remain under siege. These crimes harm all of us - government agencies and programs, insurers and healthcare providers, and individual patients.  But we are fighting back, and will use the expanded capabilities that the Affordable Care Act provides to stop healthcare fraud in its tracks."

Targeting 'hot' spots

Project HEAT (Health Care Fraud Prevention and Enforcement Action Team) is a the operation between DOJ, CMS and the HHS Office of Inspector General  that has unleashed special strike forces in six states to target  healthcare fraud hot spots like South Florida, New York, Texas, California, Louisiana and Michigan. 

"Criminals have concluded that healthcare fraud is a safe bet.  It is imperative that we change the calculus," said Daniel R. Levinson, Inspector General for the Department of Health and Human Services.  "With the expanded resources and enforcement tools provided in the Affordable Care Act, OIG and its partners will be bringing the fight to the criminals to prevent, detect, and swiftly punish those who steal from taxpayers and abuse the public trust."

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