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Federal Anti-Fraud Efforts Call for More Scrutiny of Providers

Janice Simmons, for HealthLeaders Media, May 14, 2010

Also in fiscal 2009, the Justice Department's Criminal Division and the U.S. Attorneys' Offices opened 1,014 new criminal healthcare fraud investigations and had 1,621 healthcare fraud criminal investigations pending, Holder said.

"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. The Justice Department’s Civil Division opened nearly 900 new civil healthcare fraud investigations and had more than 1,100 pending cases.

Holder also announced that the Medicare Fraud Strike Forces prosecutors, working as part of the joint HHS-Justice Department Health Care Fraud Prevention & Enforcement Action Team (HEAT) announced last May, have sought approximately $500 million in court ordered restitution to the Medicare program in nearly 300 healthcare fraud cases involving more than 560 defendants. The strike forces now cover seven regions of the country—from South Florida to Detroit to Houston.

Sebelius also commented on criminal schemes that have popped up with the passage of healthcare reform legislation. "In states like Delaware and Wyoming, we've heard that scam artists are calling up seniors and telling them they need to share their Medicare ID numbers in order to get the law's new benefits," she said.

In other states, seniors have been asked for personal information in order to get their "new Medicare ID cards," which don't exist.

"These are old crimes with a new spin," she said. "My message to them today is this: there has never been a worse time to try to steal Americans' healthcare dollars."


Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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