Turning Up the HEAT on Health Care Fraud

President Obama is committed to fighting health care fraud and in just over a year in office, his Administration has taken unprecedented and decisive action to stop fraud and crack down on criminals.

In May, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder pledged to fight waste, fraud and abuse in Medicare and announced the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). With the creation of HEAT, fighting Medicare fraud has become a Cabinet-level priority for both DOJ and HHS.

Expansion of the Medicare Fraud Strike Force has been a key component of HEAT.  Strike Force Teams initially began in Miami in 2007 and expanded to Los Angeles in 2008.  Since the formation of HEAT, the Strike Force has expanded further to Detroit; Houston; Brooklyn, N.Y.; Baton Rouge, La.; and Tampa Bay, Fla..To date, Strike Force teams have obtained indictments of more than 500 individuals who collectively have falsely billed the Medicare program for more than $1 billion dollars.

Other steps taken by the Administration to fight health care fraud include:

Use of new state-of-the-art technology to fight fraud

Investigators in the HHS Office of the Inspector General are implementing state-of-the-art, cutting edge technology to identify and analyze potential fraud with unprecedented speed and efficiency. Using this technology, federal law enforcement officials are receiving an unprecedented amount of data, helping them to detect more quickly potential patterns of health care fraud.

Protecting taxpayer dollars

The Justice Department's Civil Division and U.S. Attorneys' Offices have recovered approximately $2.2 billion in civil recoveries since January 2009 in cases involving fraud against federal health care programs. That amount brings the Department’s total health care fraud recoveries since 1986, when Congress substantially strengthened the civil False Claims Act, to over $16 billion in civil recoveries.  This includes the Department's announcement in September 2009 that Pfizer Inc. agreed to pay more than $2.3 billion in criminal fines and civil recoveries to resolve allegations arising from, among other things, its marketing of the drug Bextra.  This is the largest health care fraud settlement in the history of the Department.

Expansion of the CMS Demonstration project on durable medical equipment to increase site visits during the provider enrollment process

Increased site visits help ensure only legitimate providers can participate and bill for services in the Medicare program. 

New funding for Medicare Drug Integrity Contractors

Increased funding to help strengthen HHS’s ability to monitor Medicare Parts C & D (Medicare Advantage and Prescription Drug benefit) compliance and enforcement by expanding use of these contractors.

Increased education for providers.

Training providers helps prevent honest mistakes, makes providers aware of the rules and penalties, and helps stop potential fraud before it happens.

Increase support for States

Additional support is being provided to state Medicaid officials to allow them to conduct targeted activities to fight fraud in their States. 

A renewed commitment to expanded data sharing and improved information sharing procedures between HHS and the DOJ

In order to get critical data and information into the hands of law enforcement to track patterns of fraud and abuse, increased efficiency in investigating and prosecuting complex health care fraud cases, and turn off funding and profits to those who may be defrauding the system.