Anti-Health Care Fraud Efforts Stalled, According to AG
As a blogger, I do so enjoy occasions where government officials confirm my observations.
For example, last Wednesday I posted on how health care reform legislation should focus on combating fraud as a way to reduce the rapidly escalating costs of care. On Thursday, during the National Summit on Health Care Fraud held in Bethesda, Maryland, Attorney General Eric Holder disclosed that Justice Department records show that efforts to combat health care fraud have stalled in the past two years.
Holder stated that two years after the federal government ramped up its efforts to combat Medicare fraud, the number of people charged with such fraud has barely changed. Specifically, federal prosecutors have charged 803 people with defrauding medical insurers in FY 2009. (Nearly all of the charges involved Medicare fraud.) This number represents a mere 2 percent increase since the government began deploying “strike forces” to target fraud in 2007.
The 2007 strike force targeted fraud in Miami, and following the inception of the Miami program the number of people charged with health care fraud leaped nearly 35 percent. The strike force program, also known as the Health Care Fraud Prevention & Enforcement Action Team or HEAT, has since been expanded to six other cities (Detroit, Houston, Los Angeles, Baton Rouge, New York, and Tampa). Strike force efforts in the latter three cities began in December of 2009.
Notably, according to Louis Saccoccio, head of the National Health Care Anti-Fraud Association, many of the charges constitute “low hanging fruit” and while the government has generally done a good job targeting fraud, there are many undiscovered cases.
During the Summit, Attorney General Holder noted that fraud costs Medicare an estimated $60 billion a year. This is number is significantly higher than reports from the FBI, which estimates that combined fraud in all health care programs eats up 3-10 percent of total health care spending. Since the operating costs for the Medicare program in FY 2008 ran around $460.9 billion, $60 billion in losses would mean that fraud accounts for 13 percent of the Medicare budget.
After the jump - where anti-fraud efforts will be directed
Such numbers affirm the need to take additional steps to ensure that not just the most blatant fraudsters are discovered, but that unscrupulous providers who normally fly under the radar are apprehended as well. During the Summit, officials from the Departments of Justice and Health and Human Services met in “workgroups” to focus on:
- Use of technology to prevent and detect health care fraud and improper payments
- Role of states in preventing health care fraud
- Development of effective prevention policies and methods for insurers, providers and beneficiaries
- Effective law enforcement strategies
- Measuring health care fraud, assessing recoveries and determining resource needs
Summaries of the workgroup discussions will be compiled in a publicly available report, to be released at a later date. The Health Care Lawyer Blog will continue to follow such developments.
