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Department of Health and Human Services and Department of Justice team up to crack down on health care fraud

Posted Nov 04 2010 10:01pm

Secretary Sebelius and Attorney General Holder host third regional health care fraud prevention summit in Brooklyn, New York

WASHINGTON – Today the U.S. Department of Health and Human Services (HHS) Secretary, Kathleen Sebelius, and Attorney General Eric Holder visited Brooklyn, New York where they participated in the third regional health care fraud prevention summit. The summits bring together a wide array of federal, state and local partners, beneficiaries, providers and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system.  The summits are part of a larger effort on behalf of the Obama Administration to root-out waste, fraud, and abuse within the U.S. health care system.

“Here in New York and in communities across the country, health care fraud schemes are being aggressively and permanently shut down.  That’s, in large part, because of the great work being led by Health Care Fraud Prevention and Enforcement Action Team,” said Attorney General Eric Holder.  “Through this initiative, we are working in partnership with government, law enforcement and industry leaders to protect taxpayer dollars, control health care costs, and ensure the strength and integrity of our most essential health care programs.  Simply put, we have taken our fight against health case fraud to a new level.  And I am committed to continued collaboration, vigilance, and progress.”

“Today, we continue to work with patients to protect their information, with providers to strengthen screening standards, and with private insurers to share strategies about how to prevent fraud,” said HHS Secretary Kathleen Sebelius. “The Affordable Care Act gives us new resources to eliminate waste and kick criminals out of the health care system. As long as we continue to aggressively put these tools to work preventing and prosecuting fraud, we can continue to protect and strengthen Medicare’s future.”

In addition to remarks by the Secretary and the Attorney General, the summit featured four educational panels aimed at identifying best practices for providers, law enforcement, and beneficiaries in preventing health care fraud.  The HHS Office of the Inspector General also introduced a new tool for medical students called A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud Abuse.  The new booklet will go out to medical school across the country and it explains the laws that apply to physicians so they can comply with federal law, avoid liability and spot signs of potential fraud.  The Roadmap is available at http://oig.hhs.gov/fraud/PhysicianEducation/ .

The recently enacted Affordable Care Act provides additional tools and resources to fight fraud in the health care system by providing an additional $350 million over the next ten years through the Health Care Fraud and Abuse Control Account.  The Act toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across government, expands overpayment recovery efforts, and provides greater oversight of private insurance abuses.  For information on the 2009 Health Care Fraud and Abuse Control Program Report, please visit: www.justice.gov/dag/pubdoc/hcfacreport2009.pdf .

The Affordable Care Act also includes tools and resources to help states reduce improper payments through the establishment of recovery audit contractors (RACs).  Today, the Centers for Medicare & Medicaid Services (CMS) expects to propose regulations outlining steps that states need to take to implement these Affordable Act provisions.  Information about the Medicaid RACs can be found at http://www.cms.gov/apps/media/press_releases.asp and www.stopmedicarefraud.gov

Investments in fraud detection and enforcement pay for themselves many times over, and the Administration’s tough stance against fraud is already yielding results. In FY 2009, anti-fraud efforts put $2.51 billion back in the Medicare Trust Fund resulting from civil recoveries, fines in criminal matters, and administrative recoveries. This was a $569 million, or 29-percent, increase over FY 2008. In FY 2009, more than $441 million in federal Medicaid money was returned to the treasury, a 28-percent increase from FY 2008.  Most recently, in FY 2010, the Department obtained settlements and judgments of more than $2.5 billion in False Claims Act matters alleging health care fraud. This is more than ever before obtained in a single year and represents a 66% increase over FY2009 in which $1.68 billion was obtained.

New York City is responsible for many of these recoveries. On October 13, 2010, more than 70 defendants were indicted in the largest Medicare fraud scheme ever perpetrated by a single criminal enterprise. The defendants are alleged to have participated in various health care fraud-related crimes involving more than $163 million in fraudulent billing. On July 16, 2010, more than 22 defendants were charged in Brooklyn for their alleged participation in schemes to submit fraudulent claims totaling nearly $80 million.  These arrests were part of a larger, nationwide takedown that resulted in the indictment of more than 90 individuals.

The summits are part of the overall joint health care fraud fighting effort undertaken jointly by the Department of Justice and the Department of Health and Human Services through the Health Care Fraud Prevention and Enforcement Action Team (HEAT). As one part of HEAT’s efforts, Medicare Fraud Strike Force operations have expanded from South Florida and Los Angeles to a total of seven health care fraud hot spots including Houston, Texas; Detroit, Mich.; Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla. The Strike Force is a partnership between the Criminal Division’s Fraud Section, U.S. Attorneys’ Offices, HHS’ Office of Inspector General, FBI, and other federal, state and local law enforcement partners.

On June 8, 2010, President Obama announced this nationwide series of regional fraud prevention summits as part of a multi-faceted effort to crack down on health care fraud. The New York summit was the third in a series, with additional summits to follow in the coming months in Detroit, Boston, Philadelphia and Las Vegas.  Previous summits were held in Miami (July 16, 2010) and Los Angeles (August 26, 2010).

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