Obama’s Fight Against Health Fraud Gathers Steam in Chicago

Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder highlighted some of  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) at a Chicago summit highlighting a new high-tech war against health care fraud.

This marks the seventh regional healthcare fraud prevention summit hosted by the Department of Justice and HHS, bringing together a wide array of public and private partners as part of the HEAT partnership between HHS and the Department of Justice to prevent and combat health care fraud. 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, as noted in my blog earlier this year. But the administration isn’t stopping there.

“We have a simple message to criminals thinking about committing Medicare fraud: don’t even try,” said Secretary 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 Attorney General 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.”

Sebelius and Holder took the opportunity to tout several new tools provided by the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), which 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, 20 to 50 percent longer for crimes that involve more than $1 million in losses;
  • Contractors that police the Medicare program for waste, fraud and abuse will expand their work to Medicaid, Medicare Advantage and Medicare Part D 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 information so that CMS can prevent money from going to bad actors by using its authority to suspend payments to providers and suppliers engaged in suspected fraudulent activity

In addition to the almost $4.1 billion recovered last year, the Obama Administration announced several more recent accomplishments:

  • In the early phase of revalidating the enrollment of providers in Medicare, 234 providers were removed from the program because they were deceased, debarred or excluded by other federal agencies, or were found to be in false storefronts or otherwise invalid business locations;
  • In 2011, HHS revoked 4,850 Medicaid providers and suppliers and deactivated 56,733 Medicare providers and suppliers as HHS took steps to close vulnerabilities in the Medicare program;
  • In 2011, HHS saved $208 million through pre-payment edits that stop implausible claims before they’re paid;
  • Prosecutions are up: the number of individuals charged with fraud increased from 797 in fiscal year 2008 to 1,430 in fiscal 2011 – nearly a 75 percent increase;
  • In the first few weeks of enhanced site visits required under the PPACA screening requirements, HHS found 15 providers and suppliers whose business locations were non-operational and terminated their billing privileges;
  • Through outreach and engagement efforts more than 49,000 complaints of fraud from seniors and people with disabilities reported to 1-800-MEDICARE were referred for further evaluation;
  • A recent re-design of the quarterly Medicare Summary Notices received by Medicare beneficiaries makes it easier to spot and report fraud.