HHS and Justice tout collaboration to combat Medicare fraud

Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder made the announcement Tuesday. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder made the announcement Tuesday. Manuel Balce Ceneta/AP

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.”

Stay up-to-date with federal news alerts and analysis — Sign up for GovExec's email newsletters.
FROM OUR SPONSORS
JOIN THE DISCUSSION
Close [ x ] More from GovExec
 
 

Thank you for subscribing to newsletters from GovExec.com.
We think these reports might interest you:

  • Sponsored by G Suite

    Cross-Agency Teamwork, Anytime and Anywhere

    Dan McCrae, director of IT service delivery division, National Oceanic and Atmospheric Administration (NOAA)

    Download
  • Data-Centric Security vs. Database-Level Security

    Database-level encryption had its origins in the 1990s and early 2000s in response to very basic risks which largely revolved around the theft of servers, backup tapes and other physical-layer assets. As noted in Verizon’s 2014, Data Breach Investigations Report (DBIR)1, threats today are far more advanced and dangerous.

    Download
  • Federal IT Applications: Assessing Government's Core Drivers

    In order to better understand the current state of external and internal-facing agency workplace applications, Government Business Council (GBC) and Riverbed undertook an in-depth research study of federal employees. Overall, survey findings indicate that federal IT applications still face a gamut of challenges with regard to quality, reliability, and performance management.

    Download
  • PIV- I And Multifactor Authentication: The Best Defense for Federal Government Contractors

    This white paper explores NIST SP 800-171 and why compliance is critical to federal government contractors, especially those that work with the Department of Defense, as well as how leveraging PIV-I credentialing with multifactor authentication can be used as a defense against cyberattacks

    Download
  • Toward A More Innovative Government

    This research study aims to understand how state and local leaders regard their agency’s innovation efforts and what they are doing to overcome the challenges they face in successfully implementing these efforts.

    Download
  • From Volume to Value: UK’s NHS Digital Provides U.S. Healthcare Agencies A Roadmap For Value-Based Payment Models

    The U.S. healthcare industry is rapidly moving away from traditional fee-for-service models and towards value-based purchasing that reimburses physicians for quality of care in place of frequency of care.

    Download
  • GBC Flash Poll: Is Your Agency Safe?

    Federal leaders weigh in on the state of information security

    Download

When you download a report, your information may be shared with the underwriters of that document.