The Remington Report

Health Care Fraud and Abuse Control Program’s (HCFAC) report showed significant progress in fighting fraud. In fiscal year 2009, anti-fraud efforts resulted in $2.51 billion being deposited to the Medicare Trust Fund, a $569 million, or 29 percent, increase over FY 2008. In addition, over $441 million in federal Medicaid money was returned to the Treasury, a 28 percent increase from FY 2008.

The Affordable Care Act will build on innovative strategies to fight fraud, such as Project HEAT, the joint operation between DOJ, CMS and the HHS Office of Inspector General that has unleashed special strike forces in six states to target health care fraud hot spots like South Florida, New York, Texas, California, Louisiana and Michigan.

DOJ and HHS officials stressed that the expanded law enforcement efforts will be supported by the newly established Center for Program Integrity at the Centers for Medicare & Medicaid Services, which will use state-of-the-art methods to implement provisions of the Affordable Care Act that detect fraud and prevent improper payments. The Center will also work with the private health care sector to better target fraud and abuse.

At a news conference Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder said the new law provides more than $350 million during the next 10 years to fight fraud. Some of the money will be used to hire new personnel to scrutinize Medicare and Medicaid advisers, and identify and investigate schemes. Those caught would face tougher sentences than they do now.

Attorney General Holder said that more than 1,000 new health fraud investigations were started last year, with 800 indictments and almost 600 convictions. Holder also said that Health Care Fraud Prevention and Enforcement Action Teams in six states have also been successful in combating fraud. The HEAT teams investigate and make arrests in South Florida, New York, Texas, California, Louisiana and Michigan.

The money that was returned to the Medicare Trust Fund was a 29 percent increase over the previous fiscal year, when just under $2 billion was returned. In addition to that money, more than $441 million in federal Medicaid money was returned to the Treasury Department, a 28 percent increase from last fiscal year.