The federal government recovered some $4 billion in fiscal 2010 from people who tried to defraud Medicare and Medicaid, Department of Health and Human Services Secretary Kathleen Sebelius and Associate Attorney General Tom Perrelli announced Monday.
In releasing the results of an annual report, the officials cited the Justice Department and HHS led-Health Care Fraud Prevention & Enforcement Action Team (HEAT) in May 2009 and the accomplishments of the teams located throughout seven cities that enforced Medicare fraud recovery efforts. In the fiscal year that ended Sept. 30, 2010, the teams imprisoned 146 defendants and indicted 140 individuals involving charges filed against 284 defendants who collectively billed Medicare more than $590 million.
DOJ opened more than 2,000 criminal and civil health care fraud investigations, the highest number initiated in a single year, according to Perrelli.
An example of those recoveries was the Astra Zeneca case. In April 2010, Astra Zeneca LP and its subsidiary paid $520 million to resolve false claims act allegations that they illegally marketed the anti-psychotic drug Seroquell for uses not approved as safe and effective by the FDA.
DOJ alleged that between 2001 and 2006, Astra Zeneca promoted Seroquell to psychiatrists and doctors for certain uses not approved as safe and effective including Alzheimer’s disease, Attention Deficit Hyperactivity Disorder, depression and other conditions.
From day one, President Barack Obama has made it clear that particularly in these difficult financial times, eliminating fraud, waste and abuse can’t be the job of one agency or department; it needs to be the focus of every single one of us in government, Sebelius said.
HHS also announced new rules authorized by the Affordable Care Act that will aim to proactively prevent and fight fraud, waste and abuse in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).
The new rules will create a screening process for providers and suppliers in Medicare, Medicaid and CHIP to keep fraudulent providers out of the programs; require a new enrollment process that will mandate states to screen Medicaid and CHIP providers; the power to temporarily stop enrollment of potentially high-risk, new providers and suppliers; and the power to temporarily stop payments to providers and suppliers in cases of suspected fraud.
Perrelli and Sebelius were joined by the Centers for Medicare and Medicaid Services Administrator Donald Berwick, Assistant Director of the FBI’s Criminal Investigative Division Kevin Perkins, Deputy HHS Inspector General Gerald Roy and Executive Director of the Coalition Against Insurance Fraud Dennis Jay.