Strike forces target Medicare fraud

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Starting in the spring of 2007, federal, state and local law enforcement officials came together in South Florida to hunt down and charge people with defrauding the country’s multibillion-dollar Medicare system.

Known as the Medicare Fraud Strike Force and now expanded across the country, the group has since indicted more than 300 health care providers nationwide and has broken up operations that accounted for more than $700 million in fraudulent Medicare claims.

Former U.S. Attorney R. Alexander Acosta, who put a priority on health care fraud cases when he was the government’s chief prosecutor in Miami, said the decision in Washington to make such coordinated efforts permanent is starting to have an impact, but that more needs to be done to make a real dent in the kickback and false-billing schemes that plague the national health care program.

“The fight against health care fraud had already begun at the local level, but the strike forces brought additional manpower, expertise and necessary resources,” said Mr. Acosta, now dean of the Florida International University College of Law in Miami.

“They put a spotlight on a national problem, allowed us to continue our work and more than doubled the resources available to us,” he said. “It has become a very successful partnership for a too-often-ignored problem.”

Assistant Attorney General Lanny A. Breuer, who heads the Justice Department’s criminal division, told the Senate in May that federal and state spending on Medicare and Medicaid totaled $800 billion a year and that “according to various estimates, somewhere between 3 and 10 percent of this spending is lost to waste, fraud and abuse.”

Mr. Breuer told The Washington Times that because criminals are “devising more sophisticated ways of stealing billions of dollars from federally administered health care programs, and they are stealing it faster now than ever before,” the Justice Department is committed to shutting them down.

“We must stop the bleeding, and we are committed to do so,” he said.

Medicare is a government-paid insurance program begun in 1965 that provides health care to about 40 million people 65 and older and 7 million younger people with permanent disabilities. The program accounted for about 13 percent of the federal budget and 19 percent of the total health care expenditures in 2008.

Health and Human Services Secretary Kathleen Sebelius said the strike force has a “proven record of success,” using a data-driven approach to identify unexplainable billing patterns and investigate providers for fraudulent activity.

Building on early strike-force successes under President George W. Bush in South Florida in 2007 and in Los Angeles in 2008, the Obama administration created new strike-force operations in Detroit and Houston in March this year.

Program integrity

Fraud-prevention efforts also have been strengthened in President Obamas proposed fiscal 2010 budget, which invests $311 million - a 50 percent increase over fiscal 2009 - to bolster “program integrity” activities within the Medicare and Medicaid programs.

The anti-fraud efforts in the presidents budget could save $2.7 billion over five years by improving oversight and stopping fraud in the Medicare and Medicaid programs, Justice Department and HHS officials have estimated. The officials said that since the program’s inception, the strike forces have filed more than 130 cases, charged more than 300 people, accepted 15 guilty pleas and won 21 convictions in 15 jury trials.

And the number of cases has been multiplying in recent months.

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