New tools help crack down on health care fraud; last year’s Medicare enforcement recoups $2.5B

Stepped-up Medicare fraud enforcement snags $2.5B

WASHINGTON — The government says it recovered $2.5 billion in overpayments for the Medicare trust fund last year as the Obama administration focused attention on fraud enforcement efforts in the health care industry.

Investigators have new tools this year to help crack down on health care fraud, with the Justice Department and the Health and Human Services Department working cooperatively to police companies. The newly enacted Affordable Care Act is designed to lengthen prison sentences in criminal cases and the new law provides an additional $300 million over the next 10 years for stronger enforcement. It also gives the government new authority to step up oversight of companies participating in Medicare and Medicaid.

“We’re going to attack fraud at every stage of the process,” Health and Human Services Secretary Kathleen Sebelius said Thursday at a news conference.

Attorney General Eric Holder said “as long as health care fraud pays and goes unpunished, our health care system will remain under siege.”

Under the Affordable Care Act, providers could be subject to fingerprinting, site visits and criminal background checks before they begin billing Medicare and Medicaid.

To combat fraud, the act allows Health and Human Services Secretary Kathleen Sebelius to bar providers from joining the programs and allows her to withhold payment to Medicare or Medicaid providers if an investigation is pending.

In a report released Thursday, the Justice Department and HHS say they are putting investigative resources in areas where health care fraud is especially widespread, including south Florida; Los Angeles; Houston; Detroit; New York City’s Brooklyn borough; Baton Rouge, La.; and Tampa, Fla.

The result is a rising number of criminal prosecutions and the return of more stolen money to the government. At the same time, federal investigators are blocking unscrupulous companies from getting into government health care programs in the first place.

For the fiscal year that ended last Sept. 30, the federal government won or negotiated $1.63 billion in judgments and settlements, and investigators opened 1,014 new criminal health care fraud investigations involving 1,786 defendants.

Most of those figures are up from 2008, when the government won or negotiated $1 billion in judgments and settlements, and investigators opened 957 new criminal health care fraud investigations involving 1,641 potential defendants.

In 2008, the recoveries for the Medicare Trust Fund totaled $1.9 billion.