DOJ and HHS Host Second Health Care Fraud Summit

Of course, no Medicaid fraud in child welfare on the agenda.

Attorney General Holder and HHS Secretary Sebelius host second regional health care fraud prevention summit in Los Angeles

WASHINGTON - Today Attorney General Eric Holder and U. S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius kicked off the second in a series of daylong summits bringing 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 summit in Los Angeles included educational panels featuring law enforcement officials, including Assistant Attorney General Lanny A. Breuer of the Criminal Division, consumer experts, providers and key government agencies.

“In communities across the region, our health care system is under siege – exploited by criminals intent on lining their own pockets at the expense of American taxpayers, patients and private insurers,” said Attorney General Eric Holder.  “But through the Health Care Fraud Prevention and Enforcement Action Team, we are fighting back in bold, innovative and coordinated ways.  In addition, the Affordable Care Act provides new resources and includes tough penalties to help stop and prevent health care fraud.  We will continue to work vigorously with our law enforcement and private sector partners to punish those who steal from taxpayers, patients, seniors and other vulnerable Americans.”

Announced during the summit was a final regulation issued by the Centers for Medicare & Medicaid Services (CMS) increasing protections for both Medicare and Medicare beneficiaries from potentially fraudulent suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The new regulation enhances Medicare enrollment standards for DMEPOS suppliers by adding several new standards and strengthens existing standards that suppliers must meet before being able to furnish equipment and supplies to Medicare beneficiaries.

“The steps we are taking today provide us with additional tools to support our continuing efforts to reduce Medicare fraud by helping ensure that only appropriately qualified suppliers are enrolled in the program.  We know the majority of medical equipment suppliers and health care providers want to improve the health of Medicare beneficiaries, but we also know there are those who look for any opportunity to take advantage of beneficiaries and Medicare, including sham operations that are not legitimate businesses,” said Secretary Sebelius.

The summit also featured educational panels that discussed best practices for both providers and law enforcement in preventing health care fraud.  The panels included law enforcement officials, consumer experts, providers and representatives of key government agencies.

The recently enacted Affordable Care Act provides additional tools and resources to fight fraud in the health care system by providing an additional $350 million over the next 10 years through the Health Care Fraud and Abuse Control Account.

In addition, the Affordable Care Act 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, please visit www.justice.gov/dag/pubdoc/hcfacreport2009.pdf.

Investments in anti-fraud detection and enforcement pay for themselves many times over, and the Administration’s tough stance against fraud is already yielding results. In FY 2009, anti-fraud efforts put $2.51 billion back in the Medicare Trust Fund, a $569 million, or 29 percent, increase over FY 2008, and over $441 million in federal Medicaid money was returned to the treasury, a 28 percent increase from FY 2008.

The Affordable Care Act builds on innovative strategies to fight fraud, such as the Health Care Fraud Prevention and Enforcement Action Team (HEAT), the joint operation between the Department of Justice (DOJ) in partnership with the 94 U.S. Attorneys’ Offices, CMS and the HHS Office of Inspector General that has expanded Medicare Fraud Strike Force teams from South Florida and Los Angeles to now operating in seven regions to target health care fraud hot spots including Houston; Detroit; Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla.

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 Los Angeles summit was the second in a series, with additional summits to follow in the coming months in Detroit, Boston, New York, Philadelphia and Las Vegas.

On July 16, 2010, the U.S. Health and Human Services Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder kicked-off the first in a series of Regional Health Care Fraud Prevention Summits in Miami.