Sebelius, Holder launch healthcare fraud team

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U.S. Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius have launched a new interagency effort to combat Medicare fraud with the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT).

Holder and Sebelius also announced the expansion of Medicare Fraud Strike Force team operations to Detroit and Houston. These groups, currently in operation in South Florida and Los Angeles, fight Medicare fraud on a targeted local level.

"Every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud," Holder said. "Those billions represent healthcare 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 [DoJ] is committed to working with the HHS to eradicate it."

"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," Sebelius said. "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 healthcare."

The HEAT team will include senior officials from the DoJ and HHS who will strengthen existing programs to combat fraud, while investing new resources and technology to prevent fraud, waste and abuse before it happens.

Efforts will include the expansion of joint DoJ-HHS Medicare Fraud Strike Force teams that have been fighting fraud in South Florida and Los Angeles. Established in 2007, these teams have a proven record of success using a data-driven approach to identify suspicious billing patterns and investigating these providers for possible fraudulent activity.

The Medicare Fraud Strike Force team operating in South Florida has already convicted 146 defendants and secured $186 million in criminal fines and civil recoveries.  After the operations in South Florida, the Medicare Fraud Strike Force expanded in May 2008 to phase two in Los Angeles, where 37 defendants have been charged with criminal health care fraud offenses. To date, more than $55 million has been ordered in restitution to the Medicare program in Los Angeles.

The team also will build on demonstration projects by the HHS Inspector General and the Centers for Medicare & Medicaid Services (CMS) 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 CMS 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.