Obama Wants Private Sector to Help with Healthcare Fraud Fight

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."