Departments of Justice and Health and Human Services team up in Detroit to crack down on health care fraud

Departments of Justice and Health and Human Services team up in Detroit to crack down on health care fraud

Attorney General Holder and Secretary Sebelius host fifth regional health care fraud prevention summit in Michigan

WASHINGTON – Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius visited Detroit today to participate in the fifth regional health care fraud prevention summit. These summits bring together a wide array of federal, state and local partners, beneficiaries, providers and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system. The summits are part of a larger effort on behalf of the Obama Administration to root out waste, fraud and abuse within the U.S. health care system.

In Detroit, the joint efforts of the Departments of Justice (DOJ) and HHS have achieved significant results in an area with major health care fraud problems. Since May 2009, this collaboration has resulted in charges against 120 defendants, in 18 separate criminal cases, for fraud schemes totaling approximately $120 million in taxpayer funds. So far, eight of these individuals have been convicted at trial and 63 have pleaded guilty.

“Here in Detroit and communities across this region, many of you have witnessed the devastating effects of health care fraud,” said Attorney General Holder. “Through a collaborative DOJ-HHS effort, we are working in partnership with government, law enforcement and industry leaders to protect taxpayer dollars, control health care costs and ensure the strength and integrity of our most essential health care programs. The results are clear: thanks to our efforts, health care fraud schemes throughout this region and across the country are being aggressively and permanently shut down. And as we renew our commitment to this work today, I am committed to building on the progress we’ve made, continuing to collaborate with each of you, and seeking new ways to expand our operations to fight health care fraud.”

“Thanks to provisions in the Affordable Care Act, the prospects for a criminal thinking about targeting our health care system have gotten a lot gloomier,” said Secretary Sebelius. “Here in Detroit, we are honoring our commitment to America’s seniors, meeting our obligation to taxpayers, and standing up to criminals who, in the past, have gotten away with far too much.”

In addition to remarks by the Attorney General and the Secretary, the summit featured three educational panels aimed at identifying best practices for providers, law enforcement and beneficiaries in preventing health care fraud.

The summits are integral to the overall health care fraud-fighting effort undertaken jointly by DOJ and HHS through the Health Care Fraud Prevention and Enforcement Action Team (HEAT). As one part of HEAT’s efforts, Medicare Fraud Strike Force operations have expanded from South Florida and Los Angeles to a total of nine health care fraud hot spots including Houston, T.X.; Detroit, M.I.; Brooklyn, N.Y.; Baton Rouge, L.A..; Tampa, F.L.; Chicago, I.L.; and Dallas, T.X.. The Strike Force is a partnership between the Criminal Division’s Fraud Section, U.S. Attorneys’ Offices, HHS’ Office of Inspector General, Federal Bureau of Investigation (FBI) and other federal, state and local law enforcement partners. Since their inception in 2007, Strike Force operations have charged more than 1,000 defendants for Medicare fraud involving more than $2.3 billion in claims.

In addition, the Affordable Care Act provides new tools and resources to fight fraud in federal health care programs by providing an additional $350 million over the next 10 years through the Health Care Fraud and Abuse Control Account. The law 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 Health Care Fraud and Abuse Control Program Report for Fiscal Year 2010, please visit:http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2010.pdf.

For a summary of new tools and resources the Affordable Care Act has put in place to help fight fraud, visit:www.HealthCare.gov/news/factsheets/fraud03152011a.html.

Investments in fraud detection and enforcement have been shown to pay for themselves many times over, and the Administration’s tough stance against fraud is already yielding results. In FY 2010, more than $4 billion was returned to the Medicare Health Insurance Trust Fund, the U.S. Department of the Treasury and others as a result of enforcement activities targeting false claims and fraud perpetrated against government health care programs. This was an increase of $1.4 billion, or 56 percent, over FY 2009. The $4 billion recovered in FY 2010 includes recoveries from the $2.5 billion in settlements and judgments obtained in FY 2010 by the Department of Justice in False Claims Act matters alleging health care fraud. This is an unprecedented level of funds obtained in a single year and represents a 53 percent increase over FY 2009, in which $1.63 billion was obtained.

On June 8, 2010, President Obama announced this nationwide series of regional fraud prevention summits as part of a multi-faceted effort to crack down on health care fraud. The Detroit summit was the fifth in a series, with additional summits to follow in the coming months. Previous summits were held in Miami (July 16, 2010), Los Angeles (Aug. 26, 2010), Brooklyn, N.Y. (Nov. 5, 2010) and Boston (Dec. 16, 2010).