To combat healthcare fraud, Obama Administration officials met Thursday with law enforcement, government regulators, and insurance industry representatives to take steps to improve coordination and data sharing.
Noting the "staggering" loss of an estimated $60 billion in public and private healthcare funds lost each year, Attorney General Eric Holder told a National Summit on Health Care Fraud that combating fraud is one of the most urgent destructive national challenges that the administration faces.
Human and Human Services Secretary Kathleen Sebulius said the proposed 2011 budget Obama will unveil next week will "include historic support for anti-fraud efforts that will save billions of dollars over 10 years."
The plan calls for increased investment in programs that "have a proven record of preventing fraud, reducing payment errors, and returning funds to Trust Funds," Sebulius said. "The Obama Administration has zero tolerance for healthcare fraud and abuse." No detailed monetary amounts were announced.
The daylong session in Bethesda, MD, aimed to bring together pubic and private partners to establish a cooperative, national response to fraud, which officials said needs improvement.
Sandy Praeger, commissioner of the Kansas Insurance Department, said there needs to be better cooperation among the entities in health insurance.
James Roosevelt Jr., president and CEO of Tufts Health Plan in Boston, emphasized the importance of the private sector in joining the work of fighting healthcare fraud.
"Anti-fraud efforts face enormous challenges, but we know firsthand by working together with public agencies, we can increase antifraud performance." Such a partnership has "cost and quality benefits," he said. Roosevelt suggested federal officials include the private sector more and undertake "increased sharing" of public information.
After officials had a series of closed-door meetings at the conference, they discussed issues they want to investigate regarding healthcare fraud. Among them:
- A "pre-payment" intervention system instead of the "pay and chase system" in Medicaid investigations. Officials say they want to explore giving the government time to delay Medicaid providers when waste, fraud or abuse is suspected. Currently, federal law requires that Medicaid send payments within a short time regardless of whether fraud is suspected.
- Improved coordination of state enforcement efforts in preventing healthcare fraud.
- Engaging families to identify fraud and abuse.
- Changing identification numbers so healthcare doesn't rely on Social Security numbers.
Fraud team expansion
The Obama Administration intends to expand a law enforcement initiative known as Health Care Fraud Prevention and Enforcement Action (HEAT), which was initiated last May. Authorities also are expected to expand Medicare Strike Forces.
"HEAT has proven that better collaboration is the key to combating these crimes, recovering stolen resources and protecting essential Medicare and Medicaid dollars," Holder said.
Last year, the Justice Department charged 800 defendants with healthcare fraud, an all-time high, with Holter saying the "scope of the problem is simply shocking." Prosecutors obtained more than 580 criminal convictions. In civil enforcement actions, the department recovered $2.2 billion.
"One estimate suggests that more than $60 billion in public and private health funds are lost each year on healthcare fraud," Holter said. "That is a staggering amount of money."
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
