Wednesday, May 20, 2009

Attorney General Holder and HHS Secretary Sebelius Announce New Interagency Health Care Fraud Prevention and Enforcement Action Team

Attorney General Eric Holder and Health and Human Services (HHS)
Secretary Kathleen Sebelius today announced the creation of a new
interagency effort, the Health Care Fraud Prevention and Enforcement
Action Team (HEAT), to combat Medicare fraud. Holder and Sebelius also
announced the 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.

"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 Attorney General 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."

The HEAT team will include senior officials from DOJ and HHS who will
build upon and strengthen existing programs to combat fraud while also
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 successfully 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 unexplainable 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 success of 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 in the Los Angeles cases, more than $55 million
has been ordered in restitution to the Medicare program.

"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
Attorney General Holder.

Prevention is critical to reforming the system and the HEAT team will
also focus critical resources on preventing fraud from occurring in the
first place. The team 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

* 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.

The Attorney General and the HHS Secretary also called on the American
people to visit a new Web site or call
1-800-HHS-TIPS (1-800-447-8477) to report suspected Medicare fraud.

"The American people are some of our best weapons in the fight against
Medicare fraud," added Sebelius. "Fraud is happening in communities
across the country right now and we need the American people to blow the
whistle on thieves and criminals who are stealing from all of us."

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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