May 2009 marked a stepped-up assault against Medicare fraud and any other type of fraudulent activity aimed at defrauding the US government’s health care system.
It was then Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius told the world of the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT).
They also assigned health care fraud detection and prosecution as a Cabinet-level priority at both departments.
HEAT’s mission, as they described it, included:
- Marshaling cross-government resources to attack fraud and abuse in Medicaid and Medicare programs
- Ridding the system of perpetrators preying on Medicare and Medicaid beneficiaries
- Highlighting and heralding providers and public sector employees who dedicate themselves to detecting and stopping Medicare fraud, waste and abuse
- Strengthening existing alliances between the two agencies, with special emphasis on the Medicare Fraud Strike Forces to save taxpayer dollars by reducing health care fraud
The alliance has succeeded already. In fiscal year 2009, the Department of Justice’s (DOJ) 94 US Attorneys’ Offices, HHS’s Office of the Inspector General and the Centers for Medicare and Medicaid Services (CMS) tallied the following wins:
- Filed charges of health care fraud violations against over 800 people
- Secured 583 criminal convictions
- Obtained 337 civil administrative actions
- Recovered more than $2.5 billion in criminal, civil and administrative actions
Education is another arm of their joint efforts. Holder and Sebelius sent letters to all state attorneys general urging their close cooperation with HHS and law enforcement at all levels to educate seniors and other health care beneficiaries how to prevent Medicare fraud and other health care scams.
HEAT is also picking its battles. It has identified new enforcement initiatives in the pharmaceutical and device areas to increase efficiencies and raise the level of oversight.
One successful initiative has been the establishment of Medicare Fraud Strike Forces, teams comprised of members from the US Attorneys’ offices, the FBI, CMS and HHS’s Office of the Inspector General.
Early successes in initial offices in South Florida and Los Angeles have spawned others in Houston, Detroit, Brooklyn, Baton Rouge and Tampa.
Since 2009, the Strike Forces have scored more than 800 defendant charges, with accusations of Medicare fraud to the tune of $1.9 billion.
The False Claims Act has been a sharp sword used by federal prosecutors to stem health care fraud. Since the Act’s major amendments in 1986, it has been instrumental in the DOJ’s recovery of nearly $16 billion in cases involving health care fraud.
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The DOJ and HHS have increased their data and information sharing policies and procedures to enable closer and faster investigations by law enforcement agencies across the US.
Their efforts are not always prosecutorial. A major initiative has been set in motion to increase training to stop honest mistakes and stop potential fraud before it happens.
January 2010 marked the first ever National Summit on Health Care Fraud. It brought together leaders from both the public and private sectors to discuss and identify innovative methods to stem and prevent fraud, abuse and waste in the health care system.