U.S. government efforts in health care fraud prevention and enforcement yielded more than $4 billion during fiscal 2010, the highest annual amount ever recovered from people who attempted to defraud seniors and taxpayers, and from those who sought payments to which they were not entitled.
Associate Attorney General Tom Perrelli and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the recovery efforts on Monday, along with new rules authorized by the Affordable Care Act that will help HHS prevent and fight fraud, waste and abuse in Medicare, Medicaid and the Childrens Health Insurance Program.
“Our aggressive pursuit of health care fraud has resulted in the largest recovery of taxpayer dollars in the history of the Justice Department,” Mr. Perrelli said. “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 health care programs,” he said.
Mrs. Sebelius said the Obama administration has “made it very clear” that fraud and abuse of taxpayers dollars are unacceptable and that for too long “our fraud prevention efforts have focused on chasing after taxpayer dollars after they have already been paid out.
“Thanks to the presidents leadership and the new tools provided by the Affordable Care Act, we can focus on stopping fraud before it happens,” she said.
The Health Care Fraud Prevention and Enforcement Action Team (HEAT) was created in 2009 to prevent waste, fraud and abuse in the Medicare and Medicaid programs, and to crack down on those abusing the system and costing American taxpayers billions of dollars.
Justice and HHS have enhanced their coordination through HEAT and have expanded Medicare Fraud Strike Force teams since their creation. The two agencies also have held regional fraud prevention summits and sent letters to state attorneys general urging them to work with HHS and federal, state and local law enforcement officials to mount a substantial outreach campaign to educate seniors and other Medicare beneficiaries on how to prevent scams and fraud.
In fiscal 2010, the number of cities with strike force prosecution teams was increased to seven, all with investigators and prosecutors dedicated to fighting fraud. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by criminals masquerading as health care providers or suppliers.
Mr. Perrelli said the teams brought 140 indictments against 284 defendants who collectively billed the Medicare program more than $590 million; negotiated 217 guilty pleas and litigated 19 jury trials, winning guilty verdicts against 23 defendants; and saw the sentencing of 146 defendants to prison during the fiscal year, averaging more than 40 months of incarceration.
In addition, he said federal prosecutors opened 1,116 criminal health care fraud investigations as of the end of fiscal 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.
He said fiscal 2010 also was a record year for recoveries obtained in civil health care matters brought under the False Claims Act — more than $2.5 billion, the largest in the history of the Justice Department.
Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, said that because of the new law, his agency now has additional resources to help detect fraud and stop criminals from getting into the system.
He said the Affordable Care Acts new authorities “allow us to develop sophisticated, new systems of monitoring and oversight to not only help us crack down on fraudulent activity scamming these programs, but also help us to prevent the loss of taxpayer dollars across the board for millions of American health care consumers.”