Holder and Sebelius Announce Major New Medicare Fraud Initiative
By | May 20, 2009 2:34 pm

Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius just announced a new initiative to combat Medicare fraud.  The interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), will coincide with an expansion of Strike Force team operations to Detroit and Houston.  Medicare Fraud Strike Forces, currently in operation in South Florida and Los Angeles, fight Medicare fraud on a targeted local level.  The first Strike Force team was established in South Florida in 2007 and has brought in $186 million in criminal ines and civil recoveries.   The Los Angeles team, created about a year ago, over $55 million has been ordered in restitution to the Medicare program.

Kathleen Sebelius

Kathleen Sebelius

“With this announcement, we raise the stakes on health care fraud by launching a new effort with increased tools, resources and a sustained focus by senior-level leadership,” said Holder.  “Every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud.  Those billions represent health care dollars that could be spent on medicine, elder care or emergency room visits, but instead are wasted on greed.  This is unacceptable, and the Justice Department is committed to working with the Department of Health and Human Services to eradicate it.”

“Today, we are turning up the heat on perpetrators who steal from the taxpayers and threaten the future of Medicare and Medicaid,” said Secretary Sebelius.  “Most providers are doing the right thing and providing care with integrity.  But we cannot and will not allow billions of dollars to be stolen from Medicare and Medicaid through fraud, waste and serious abuse of the system. It’s time to bring the fight against fraud into the 21st century and put the resources on the streets and out into the community to protect the American taxpayers and lower the cost of health care.”

“We know these strike forces work.  I believe a targeted civil and criminal enforcement strategy in these locations will have a substantial impact on deterring fraud and abuse, protecting patients and the elderly from scams, and ensuring that taxpayer funds are not stolen,” said Holder. 

The team will build on demonstration projects by the HHS Inspector General and the Centers for Medicare & Medicaid Services that focus on suppliers of durable medical equipment (DME).  These projects increase site visits to potential suppliers to prevent imposters from posing as legitimate DME providers.  Other initiatives include:

  • Increasing training for providers on Medicare compliance, offering providers the resources and the knowledge they need to help identify and prevent fraud.
  • Improving data sharing between the Centers for Medicare & Medicaid Services and law enforcement so we can identify patterns that lead to fraud.
  • Strengthening program integrity activities to monitor and ensure Medicare Parts C (Medicare Advantage plans) and D (prescription drug programs) compliance and enforcement.

You can visit the website here: www.hhs.gov/stopmedicarefraud

Fraud prevention efforts are also strengthened in President Obama’s proposed Fiscal Year 2010 budget.  The President’s budget invests $311 million – a 50 percent increase from 2009 funding – to strengthen program integrity activities within the Medicare and Medicaid programs.  Combined, the anti-fraud efforts in the President’s budget could save $2.7 billion over five years by improving oversight and stopping fraud in the Medicare and Medicaid programs, including the Medicare Advantage and Medicare prescription drug programs.

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One Comment

  1. kula705 says:

    How would someone contract with HHS to conduct audits for them?

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