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DEPARTMENTS OF JUSTICE, HEALTH AND HUMAN SERVICES HIGHLIGHT JOINT EFFORTS TO COMBAT HEALTH CARE FRAUD IN PHILADELPHIA

Posted Jun 17 2011 1:01am

Attorney General Holder and Secretary Sebelius Host Sixth Regional Fraud Prevention Summit

WASHINGTON – U.S. Attorney General Eric Holder and the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius visited Philadelphia, today where they participated in the sixth 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.

“In communities across the country, and particularly here in Philadelphia, 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. “Not only have we secured record recoveries totaling billions of dollars, we have raised awareness about these crimes and improved the ability of consumers and victims to report suspected fraud schemes. Through this initiative, we have forged partnerships to ensure the strength and integrity of our most essential health care programs.”

“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.”

At the summit, Secretary Sebelius announced that starting July 1, HHS will begin using innovative predictive modeling technology to identify fraudulent Medicare claims on a nationwide basis, and stop claims before they are paid. This initiative builds on the new anti-fraud tools and resources provided by the Affordable Care Act that are helping move CMS beyond its former “pay & chase” recovery operations to an approach that focuses on preventing fraud and abuse before payment is made.

Joining Attorney General Holder and Secretary Sebelius at the University of the Sciences in Philadelphia were Assistant Attorney General Tony West of the Civil Division and U.S. Attorney Zane D. Memeger for the Eastern District of Pennsylvania. The summit featured educational panels aimed at identifying best practices for providers, law enforcement, and beneficiaries in preventing health care fraud. The summit also showcased the success of public-private partnerships in curbing fraudulent schemes.

Philadelphia has witnessed many of the nation’s health care fraud recoveries, with a record $2.69 billion in recoveries collected by the Department of Justice in the past two calendar years. In 2009, the U.S. Attorney’s Office for the Eastern District of Pennsylvania announced a $1.415 billion joint civil and criminal resolution with pharmaceutical manufacturer Eli Lilly, the largest at that time against a single company to resolve the company’s off-label marketing of the drug Zyprexa.

Investments in fraud detection and enforcement have been shown to pay for themselves many times over, and the Administration’s tough stance against fraud is already yielding results. In FY 2010, more than $4 billion was returned to the Medicare Health Insurance Trust Fund, the U.S. Department of the Treasury and others as a result of enforcement activities targeting false claims and fraud perpetrated against government health care programs. This was an increase of $1.4 billion, or 56 percent, over FY 2009. The $4 billion recovered in FY 2010 includes recoveries from the $2.5 billion in settlements and judgments obtained in FY 2010 by the Department of Justice in False Claims Act matters alleging health care fraud. This is an unprecedented level of funds obtained in a single year and represents a 53 percent increase over FY 2009, in which $1.63 billion was obtained.

The summits are part of the overall joint health care fraud fighting effort undertaken jointly by the Departments of Justice and 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 nine health care fraud hot spots including Houston; Detroit; Brooklyn, N.Y.; Baton Rouge, La.; Tampa, Fla.; Chicago; and Dallas. 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 Philadelphia summit was the sixth in a series. Previous summits were held in Miami (July 16, 2010), Los Angeles (Aug. 26, 2010), New York (Nov. 5, 2010), Boston (Dec. 16, 2010) and Detroit (March 15, 2011).

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/archive/dag/pubdoc/hcfacreport2009.pdf .

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov .


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