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HHS and DOJ Turn up the HEAT: Anti-fraud Efforts Net Record Results

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  • In CMS
  • April 12, 2012
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At a Chicago health care fraud prevention summit hosted by the Department of Justice (DOJ) and the U.S. Department of Health & Human Services (HHS) in early April, HHS Secretary Kathleen Sebelius and Attorney General Eric Holder discussed how the Affordable Care Act and the Obama administration’s Health Care Fraud Prevention and Enforcement Action Team (HEAT) are fighting Medicare fraud. For the second year in a row in 2011, HEAT’s anti-fraud efforts have resulted in more than $4 billion in recoveries, according to an HHS press release. The nearly $4.1 billion recovered last year is a new record.
“We have a simple message to criminals thinking about committing Medicare fraud,” Secretary Sebelius advised. “Don’t even try.”
“Through HEAT, we have achieved unprecedented, record-breaking successes in combating health care fraud,” Attorney General Holder continued. “As a result of the Affordable Care Act, we have additional critical resources, tools and authorities to continue this great success.”
Among the new tools Holder mentions:

  • Criminals face tougher sentences for health care fraud, 20-50 percent longer for crimes that involve more than $1 million in losses.
  • Contractors that police Medicare for waste, fraud, and abuse will expand their work to Medicaid, Medicare Advantage, and Medicare Part D programs.
  • Government entities, including states, the Centers for Medicare & Medicaid Services (CMS), and law enforcement partners at the Office of the Inspector General (OIG) and DOJ, have greater ability to work together and share information.

Specific anti-fraud achievements touted by the HHS in its press release include:

  • In the early phase of revalidating the enrollment of providers in Medicare, 234 providers were removed from the program because they were deceased, debarred, or excluded by other federal agencies, or were found to be in false storefronts or otherwise invalid business locations;
  • In 2011, HHS revoked 4,850 Medicaid providers and suppliers and deactivated 56,733 Medicare providers and suppliers as it took steps to close vulnerabilities in Medicare;
  • In 2011, HHS saved $208 million through pre-payment edits that stop implausible claims before they are paid;
  • Prosecutions are up: the number of individuals charged with fraud increased from 797 in 2008 to 1,430 in 2011 – nearly a 75 percent increase;
  • In the first few weeks of enhanced site visits required under the ACA screening requirements, HHS found 15 providers and suppliers whose business locations were non-operational and terminated their billing privileges;
  • Through outreach and engagement efforts more than 49,000 complaints of fraud from seniors and people with disabilities reported to 1-800-MEDICARE were referred for further evaluation; and
  • A recent redesign of the quarterly Medicare Summary Notices received by Medicare beneficiaries makes it easier to spot and report fraud.

For more on the Obama administration’s HEAT, check out the Medicare Fraud Fact Sheet.

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