From the Department of Health and Human Services
Joint DOJ & HHS efforts result in largest sum
ever recovered in single year; new rules under the Affordable Care Act will keep
fraudulent providers and suppliers out of Medicare, Medicaid, CHIP and avoid
payments of fraudulent claims
U.S. Department of Health and Human Services (HHS) Secretary Kathleen
Sebelius and U.S. Associate Attorney General Thomas J. Perrelli today announced
a new report showing that the government’s health care fraud prevention and
enforcement efforts recovered more than $4 billion in taxpayer dollars in Fiscal
Year (FY) 2010. This is the highest annual amount ever recovered from people
who attempted to defraud seniors and taxpayers. In addition, HHS today
announced new rules authorized by the Affordable Care Act that will help the
department work proactively to prevent and fight fraud, waste and abuse in
Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).
These findings, released today, in the annual Health Care Fraud and Abuse
Control Program (HCFAC) report, are a result of President Obama making the
elimination of fraud, waste, and abuse a top priority in his administration.
The success of this joint Department of Justice (DOJ) and HHS effort would not
have been possible without the Health Care Fraud Prevention & Enforcement
Action Team (HEAT), created in 2009 to prevent waste, fraud and abuse in the
Medicare and Medicaid programs and to crack down on the fraud perpetrators who
are abusing the system and costing American taxpayers billions of dollars.
These efforts to reduce fraud will continue to improve with the new tools and
resources provided by the Affordable Care Act, including the new rules announced
“President Obama has made it very clear that fraud and abuse of taxpayers’
dollars are unacceptable. And for too long, our fraud prevention efforts have
focused on chasing after taxpayer dollars after they have already been paid
out,” said Sebelius. “Thanks to the President’s leadership and the new tools
provided by the Affordable Care Act, we can focus on stopping fraud before it
“Our aggressive pursuit of health care fraud has resulted in the largest
recovery of taxpayer dollars in the history of the Justice Department,” said
Perrelli. “These actions are in large part because of the great work being led
by the Health Care Fraud Prevention and Enforcement Action Team. Through this
initiative, we are working in partnership with government, law enforcement and
industry leaders, and the public to protect taxpayer dollars, control health
care costs, and ensure the strength and integrity of our most essential health
Health Care Fraud and Abuse Control Program Report
More than $4 billion stolen from federal health care programs was recovered
and returned to the Medicare Health Insurance Trust Fund, the Treasury, and
others in FY 2010. This is an unprecedented achievement for the Health Care
Fraud and Abuse Control Program (HCFAC), a joint effort of the two departments
to coordinate federal, state, and local law enforcement activities to fight
health care fraud and abuse.
The Affordable Care Act provides additional tools and resources to help fight
fraud that will help boost these efforts, including an additional $350 million
for HCFAC activities. The administration is already using tools authorized by
the Affordable Care Act, including enhanced screenings and enrollment
requirements, increased data sharing across government, expanded overpayment
recovery efforts, and greater oversight of private insurance abuses.
HHS and DOJ have enhanced their coordination through HEAT and have expanded
Medicare Fraud Strike Force teams since 2009. HHS and DOJ hosted a series of
regional fraud prevention summits around the country, and sent letters to state
attorneys general urging them to work with HHS and federal, state and local law
enforcement officials to mount a substantial outreach campaign to educate
seniors and other Medicare beneficiaries about how to prevent scams and fraud.
During FY 2010, HEAT and the Medicare Fraud Strike Force expanded local
partnerships and helped educate Medicare beneficiaries about how to protect
themselves against fraud.
In FY 2010, the total number of cities with Strike Force prosecution teams
was increased to seven, all of which have teams of investigators and prosecutors
dedicated to fighting fraud. The Strike Force teams use advanced data analysis
techniques to identify high-billing levels in health care fraud hot spots so
that interagency teams can target emerging or migrating schemes along with
chronic fraud by criminals masquerading as health care providers or suppliers.
Strike Force enforcement accomplishments in all seven cities during FY 2010
Including Strike Force matters, federal prosecutors opened 1,116 criminal
health care fraud investigations as of the end of FY 2010, and filed criminal
charges in 488 cases involving 931 defendants. A total of 726 defendants were
convicted for health care fraud-related crimes during the year.
In addition to these criminal enforcement successes, 2010 was a record year
for recoveries obtained in civil health care matters brought under the False
Claims Act—more than $2.5 billion, which is the largest in the history of the
Department of Justice.
The HCFAC annual report can be found here, oig.hhs.gov/publications/hcfac.asp. For more
information on the joint DOJ-HHS Strike Force activities, visit: http://www.StopMedicareFraud.gov/.
New Affordable Care Act Rules to Fight Fraud
Today, HHS also announced new rules authorized by the Affordable Care Act
which will help stop health care fraud. The provisions of the Affordable Care
Act implemented through this final rule include new provider screening and
enforcement measures to help keep bad actors out of Medicare, Medicaid and
CHIP. The final rule also contains important authority to suspend payments when
a credible allegation of fraud is being investigated.
“Thanks to the new law, CMS now has additional resources to help detect fraud
and stop criminals from getting into the system in the first place," CMS
Administrator Donald Berwick, M.D. said. “The Affordable Care Act’s new
authorities allow us to develop sophisticated, new systems of monitoring and
oversight to not only help us crack down on fraudulent activity scamming these
programs, but also help us to prevent the loss of taxpayer dollars across the
board for millions of American health care consumers.” Specifically, the
A copy of the regulation is on display today at the Federal Register and may
be downloaded from the following link: www.ofr.gov/inspection.aspx. Several days after the
regulation is published, the preceding link will be deactivated and the
published version of the regulation will be available on the National Archives
website at www.archives.gov/federal-register/news.html. CMS
will continue to take public comments on limited areas of this final rule for 60
More information can be found at www.HealthCare.gov, a web portal made available by
the U.S. Department of Health and Human Services. A fact sheet on the new rules
is available at www.HealthCare.gov/news/factsheets.
These new rules are promising in the sense that it can be of help in the prevention of fraud in the healthcare sector. However the enforcement of this should be done with much effort so that the aimed results can be achieved. Hopefully, this will be the key in eradicating fraud.