Medicare Fraud Recovery Efforts Totaled $4 Billion

Government fraud-fighting initiatives recovered more than $4 billion in taxpayer dollars in 2010.

Health care fraud and prevention efforts recovered more than $4 billion in taxpayer funds in 2010, officials from the US Department of Health and Human Services (HHS) reported yesterday. The record amount—the highest ever to be recovered in a single year—directly reflects the Obama administration’s priorities, HHS Secretary Kathleen Sebelius said in a statement.

“President Obama has made it very clear that fraud and abuse of taxpayers’ dollars are unacceptable. And for too long, our fraud prevention efforts have focused on chasing after taxpayer dollars after they have already been paid out,” she said.

The government’s stepped-up efforts were made possible by the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint project of HHS and the Department of Justice that convened in 2009 to crack down on perpetrators attempting to abuse the system and defraud seniors for personal gain.

HEAT facilitated enhanced coordination between HHS and DOJ, which, along with the expansion of Medicare Fraud Strike Force Teams, led to the conviction of 726 defendants in 2010. A major component of their efforts was an outreach campaign designed to educate seniors and other Medicare beneficiaries on how to prevent scams and fraud.

Federal officials expect bigger gains in 2011, as new rules included in the Patient Protection and Affordable Care Act take effect. These include more rigorous screening requirements for providers and suppliers seeking to participate in Medicare, Medicaid, and the Children’s Health Insurance Program. The new rules will also authorize the government to stop payments to suspected perpetrators.

How these new rules might affect pharmacies remains to be seen. Earlier this year, the National Association of Chain Drug Stores (NACDS) commended the Centers for Medicare & Medicaid Services (CMS) for adopting what it called a “common-sense approach” to fraud, waste, and abuse policies.

“However,” the group stated, “we also support policies that are based on risk, rather than one size fits all requirements that place unnecessary burdens on legitimate providers.” In the same statement, NACDS said it would continue seeking opportunities to work with CMS administrators to develop those policies.

CMS Administrator Donald Berwick is confident in the new rules and their potential to recoup funds while helping government health programs run more smoothly. “Thanks to the new law, CMS now has additional resources to help detect fraud and stop criminals from getting into the system in the first place,” he said.

He added that the new oversight will “not only help us crack down on fraudulent activity scamming these programs, but also help us to prevent the loss of taxpayer dollars across the board for millions of American health care consumers.”

For other articles in this issue, see:

• Tai-Chi, Fewer Meds May Prevent Falls in Elderly
• 1 in 5 Americans Have No Regular Physician