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Tony West: Waging War on Medicare, Medicaid Fraud

John Commins, for HealthLeaders Media, December 2, 2010

"It's been very damaging. Some people view Medicare fraud as a victimless crime because you don’t see it in the same way you would see street crime. But it really does damage the integrity of our public healthcare programs, which so many Americans depend upon for their care," West says.

"We lose so much of our hard-earned taxpayer dollars because of fraud. We have been able to bring back in the last year-and-a-half over $4 billion lost to healthcare fraud. While there is more than that that is being lost to fraud, it does represent an increase because we have been so aggressive cracking down on it."

In May 2009, HHS and DOJ joined forces to create HEAT, the Healthcare Fraud Prevention and Enforcement Action Team, and West says it's working.

"Every year, we have seen an increase in our ability to bring back taxpayer dollars lost to fraud," he said. "The cases do have a deterrent effect. If you look at the criminal side, you've seen an increase in our healthcare strike forces that we have set up around the country. We have seen an increase in the number of criminal defendants that have been arrested and are going to trial and are being held accountable."

West acknowledges that the crackdown on Medicare and Medicaid fraud is also highly symbolic now, as the Obama Administration begins implementing the complex healthcare reforms.

"When you look at the Medicare/Medicaid system, you are talking about trillions of dollars. It is just immense. The millions of Americans that rely on those two programs and the lives they touch is very far reaching and wide ranging," he says. "The fact that we can not only do the job of administering those two programs that help so many Americans, but at the same time crack down on waste fraud and abuse where we see it, and really step up the number of individuals and companies that we hold accountable for healthcare fraud is a testament to the work we have been doing over the past two years."


John Commins is a senior editor with HealthLeaders Media.

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