HHS and Justice tout collaboration to combat Medicare fraud

Calling the 2010 health care reform law “the most significant anti-health fraud law in American history,” Health and Human Services Secretary Kathleen Sebelius on Tuesday joined with Attorney General Eric Holder to announce that a record of almost $4.1 billion in taxpayer dollars were recovered in fiscal 2011 from individuals and companies that had defrauded the Medicare program.

In releasing an annual report of the joint Justice-HHS Health Care Fraud and Abuse Control Program, the two Cabinet members said at a press conference that investigations and convictions both criminal and civil had risen in large part because of the fraud prevention and enforcement action team the Obama administration set up in 2009, and because of the extra $350 million in funding provided under the Affordable Care Act.

In fiscal 2011, Justice strike force operations charged a record number of 323 defendants, who allegedly billed the Medicare program collectively for more than $1 billion, the report said. The department secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. Another $2.4 billion was recovered through civil cases brought under the False Claims Act.

“These are stunning numbers,” Holder said, “and they wouldn’t be possible without the two agencies working collaboratively.”

Much of the fraud is committed by sellers of durable medical equipment and home health providers, the officials said, as well as pharmaceutical products marketed for uses not approved by the Food and Drug Administration.

Holder said he expanded his strike forces to nine new locations that Medicare data show to be hot spots of heavy billing.

Sebelius credited improved technological screening of submitted bills that appear suspicious, comparing the process to credit card companies’ computer programs that automatically kick out a bulge in purchases of, for example, multiple flat-screen televisions.

“We’re getting away from the old pay-and-chase model by making it harder to commit the fraud in the first place,” she said.

Companies that are terminated from one Medicare program due to fraud are now terminated from all programs, she added, as are those who lie on applications.

“It sends a message to criminals that the days of easy money through stealing from Medicare have come to an end,” Sebelius said. “We’re gaining the upper hand. It’s one of the best investments we can make for the taxpayer.”