The Fight Against Health Care Fraud Affects More Than Reporting Firm
The U.S. Department of Health and Human Services has been conducting regional seminars aimed at identifying best practices for providers, law enforcement and beneficiaries in preventing health care fraud. The HHS Office of the Inspector General (OIG) also introduced a new tool for medical students called, “A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud Abuse.” The new program will go out to medical school across the country and explains the laws that apply to physicians so they can comply with federal law, avoid liability and spot signs of potential fraud. The “Roadmap” is available at www.oig.hhs.gov/fraud/PhysicianEducation.
The recently enacted Affordable Care Act provides an additional $350 million over the next 10 years through the Health Care Fraud and Abuse Control Account. The act also toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across government, expands overpayment recovery efforts and provides greater oversight of private insurance abuses. For information on the 2009 Health Care Fraud and Abuse Control Program Report, visit: www.justice.gov/dag/pubdoc/hcfacreport2009.pdf.
The Affordable Care Act also includes tools and resources to help states reduce improper payments through the establishment of recovery audit contractors (RACs). The Centers for Medicare & Medicaid Services has proposed regulations outlining steps that states need to take to implement these Affordable Act provisions. Information about the Medicaid RACs can be found at www.cms.gov/apps/media/press_releases.asp and at: www.stopmedicarefraud.gov.
Investments in fraud detection and enforcement pay for themselves many times over. In FY 2009, the government’s anti-fraud efforts put $2.51 billion back in the Medicare Trust Fund, resulting from civil recoveries, fines in criminal matters and administrative recoveries, according to the Obama Administration. This was a $569 million, or 29 percent, increase over FY 2008. In FY 2009, more than $441 million in federal Medicaid money was returned to the Treasury, a 28 percent increase from FY 2008. Most recently, in FY 2010, the Administration said it obtained settlements and judgments of more than $2.5 billion in False Claims Act matters alleging health care fraud. This is more than ever before obtained in a single year and represents a 66 percent increase over FY 2009 in which $1.68 billion was obtained.
New York City is responsible for many of these recoveries. On Oct.13, 2010, more than 70 defendants were indicted in the largest Medicare fraud scheme ever perpetrated by a single criminal enterprise. The defendants are alleged to have participated in various health care fraud-related crimes involving more than $163 million in fraudulent billing. On July 16, 2010, more than 22 defendants were charged in Brooklyn for their alleged participation in schemes to submit fraudulent claims totaling nearly $80 million. These arrests were part of a larger, nationwide takedown that resulted in the indictment of more than 90 individuals.
Source: U.S. Department of Health and Human Services
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