Obama administration cracks down on health care fraud

Modern Healthcare: "The government's efforts to rein in Medicare fraud and abuse recovered $2.5 billion for the program in fiscal 2009, up 29% from $1.9 billion the previous year, according to a new annual report. ... The $2.5 billion collected in fiscal 2009 is attributed to judgments and settlements in previous years as well as 2009, according to the report of the Health Care Fraud and Abuse Control Program. Another $441 million was returned to the treasury as the federal share of Medicaid recoveries. In the criminal realm of healthcare fraud in fiscal 2009, the Justice Department opened 1,014 new investigations compared with 953 in fiscal 2008. Prosecutors charged 803 defendants and won 583 convictions. Those numbers don't differ significantly from the previous year" (Blesch, 5/13).

The Associated Press: "The newly enacted Affordable Care Act is designed to lengthen prison sentences in criminal cases and the new law provides an additional $300 million over the next 10 years for stronger enforcement. It also gives the government new authority to step up oversight of companies participating in Medicare and Medicaid. ... Under the Affordable Care Act, providers could be subject to fingerprinting, site visits and criminal background checks before they begin billing Medicare and Medicaid. To combat fraud, the act allows Health and Human Services Secretary Kathleen Sebelius to bar providers from joining the programs and allows her to withhold payment to Medicare or Medicaid providers if an investigation is pending" (Yost, 5/13).

CQ Healthbeat: "HHS and the Justice Department will work with a new Medicare program called the Center for Program Integrity that will build on the success of joint HHS-Justice task forces that focus on ferreting out fraud in problem regions of the country" (Norman, 5/13).

Kaiser Health News: "'For years, we tolerated health care fraud' as part of the waste that comes inherent with such a large system, Sebelius said, adding that the government pays $1 billion a day in claims to providers. 'But those days are coming to an end'" (Villegas, 5/13).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.