Medicare fraud busts increase, as federal hammer comes down hard

Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius have announced the results of the latest annual report on federal efforts to combat healthcare fraud, showing an increase of 29 percent more funds recovered over the previous year.

The report indicated more arrests this past year and more Medicare funding returned to federal coffers.

According to Holder, the report, based on fiscal year 2009, showed the federal government reclaimed $2.51 billion in Medicare funding, a $569 million, or 29 percent, increase over FY 2008.

Also in 2009, more than $441 million in federal Medicaid money was returned to the Treasury, a 28 percent increase from FY 2008, Holder said at a Thursday press conference.

According to Holder, the Justice Department's Criminal Division and U.S. Attorneys' Offices opened more than 1,000 new criminal healthcare fraud investigations and had more than 1,600 healthcare fraud criminal investigations pending in 2009.

"We reached an all-time high in the number of healthcare fraud defendants charged, with more than 800 indictments in nearly 500 cases and close to 600 convictions," Holder said. "And the Justice Department's Civil Division opened nearly 900 new civil healthcare fraud investigations and had more than 1,100 pending cases."

Holder and Sebelius said the federal government plans to continue ramping up enforcement efforts. Measures in the new healthcare reform law target fraud offenders and give enforcers more funding for fraud-fighting.

The Affordable Care Act has some of the strongest anti-healthcare fraud provisions in history, Sebelius said. The measures include a tougher enrollment process for providers who wish to participate in Medicare, more cross-agency cooperation in tracking fraud and higher penalties for violators.

Sebelius said recent cases have uncovered individuals promising medical benefits to seniors in exchange for their personal information.

"Sadly, criminals see health insurance reform an opportunity to launch new schemes," she said. "My message to them is this: There has never been a worse time to try to steal Americans' healthcare dollars."

The best deterrent is education, she said. As part of anti-fraud efforts, the HHS plans to enlist seniors to alert other seniors to the dangers of fraud by expanding on an existing program known as Senior Medicare Patrol.

Under the healthcare reform law, the federal government will invest $600 million toward detection and enforcement efforts over the next 10 years – "investments that studies have shown pay for themselves many times over," Sebelius said.

Is this story relevant to you?