The US Justice Department created the Health Care Fraud Prevention and Enforcement Action Team, or “HEAT,” program to put a dent in the fraud perpetrated against Medicare and Medicaid. For details on HEAT, click here The problem with the HEAT program is that it is limited to four states and ignores the vast majority of the country.
The Justice Department claims, rather naively that:
"Most health care providers are doing the right thing and providing care with integrity. But sadly, due to the illegal actions of a small but active group of heath care fraud perpetrators, billions of dollars are stolen from taxpayers each year. Medicare fraud schemes have grown bolder and more elaborate, resulting in billions of dollars in false billings and fraud schemes which are robbing Medicare and Medicaid blind and leaving our most vulnerable citizens at
risk. Medicare fraud affects every American. Not only is waste, fraud and abuse taking critical resources out of our health care system, it contributes to the rising cost of health care for all Americans and harms the short-term and long-term solvency of these essential programs.
"Eliminating fraud will cut costs for families, businesses and the federal budget and increase the quality of services for those who need care. The U.S. Department of Health and Human Services (HHS) and U.S. Department of Justice (DOJ) are working together to help eliminate fraud and investigate fraudulent Medicare and Medicaid operators who are cheating the system. Attorney General
Eric Holder and HHS Secretary Kathleen Sebelius are taking the fight against Medicare and Medicaid fraud to a new level. They have committed senior officials from HHS and DOJ to work together on the Health Care Fraud Prevention and Enforcement Action Team (HEAT)."
The HEAT Team will expand efforts to stop fraud and prevent it from happening in the first place. These efforts will include:
Stopping Those Who Perpetrate Fraud:
• Continuing to utilize Strike Force teams that fight fraud in Miami and Los Angeles;
• Creating Strike Force teams in Detroit and Houston; and
• Helping State Medicaid officials conduct provider audits and monitor activities to detect fraudulent activities.
• Using modern technology to complete in a matter of days analysis of electronic evidence that previously took months to analyze using traditional investigative tools.
• Background on the Health Care Fraud Prevention and Enforcement Action Team.
• Criminal Prosecution as a Deterrent to Health Care Fraud, Testimony of Lanny Breuer, Assistant Attorney General for the Criminal Division, before the Senate Judiciary
Committee's Subcommittee on Crime and Drugs, 5/20/2009.
According to the Justice Department, in criminal enforcement actions during 2008, Department prosecutors:
1. Opened 957 new criminal health care fraud investigations involving 1,641 defendants, and had 1,600 criminal health care fraud investigations involving 2,580 potential defendants pending at the end of the fiscal year; and
2. Filed criminal charges in 502 health care fraud cases involving charges against 797 defendants and obtained 588 convictions for the year. Each of these figures represents an “all time high” count of federal criminal cases, defendants, and convictions.
Another 773 criminal health care fraud cases involving 1,335 defendants were pending at the end of FY 2008. In 2008, the Government charged 37 defendants in 21 indictments involving more than $55 million in fraudulent Medicare claims .
Since its inception two years ago, the Strike Force, with a limited number of investigators and prosecutors, has:
• filed 108 cases charging 196 defendants who collectively billed the Medicare program more than half a billion dollars;
• taken 129 guilty pleas;
• handled 14 jury trials resulting in convictions of 18 defendants; and
• obtained 109 sentences of imprisonment, ranging from 30 years to 4 months of home confinement, with an average term of imprisonment of 48 months.
It seems strange to hear politicians claim that they will save $500 billion by reducing fraud and abuse when with a special task force in place the US filed only 108 cases charging 196 defendants in two years and took only 14 cases to trial regarding 18 defendants with minimal recoveries from the participants. To effectively limit health insurance fraud (both against government and private
insurance programs) that steal over $100 billion every year it will be necessary to do more than pilot projects that have only covered four cities in four years.
It is time to properly fund the enforcement divisions and get more serious verdicts like some of those reported in the “Good News” sections below.
For more information on this and related topics, click here.
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