MedCity Influencers

Government to try and plug ‘dounut hole’ fraud

The federal government is bringing more heat to bear on would-be Medicare fraudsters — make that HEAT. That’s the acronym for the Health Care Fraud Prevention Enforcement Action Team, a joint effort between the Dept. of Health & Human Services and the U.S. Dept. of Justice. In a letter from HHS secretary Kathleen Sebelius and […]

The federal government is bringing more heat to bear on would-be Medicare fraudsters — make that HEAT.

That’s the acronym for the Health Care Fraud Prevention Enforcement Action Team, a joint effort between the Dept. of Health & Human Services and the U.S. Dept. of Justice. In a letter from HHS secretary Kathleen Sebelius and U.S. attorney general Eric Holder, the cabinet heads ask the states attorneys general for help in cracking down on Medicare scams.

“We are heading into the week when our first tax-free $250 donut hole rebate checks will be mailed out to Medicare beneficiaries who have fallen into the coverage gap. Accordingly, we are especially concerned about fraud and increased activity by criminals seeking to defraud seniors — and we are seeking your help to stop it,” Sebelius and Holder wrote. “Building on our record of aggressive action, we will use the new tools and resources provided by the Affordable Care Act to further crack down on fraud.”

The HEAT program has already resulted in a string of high-profile busts. Last October, federal authorities in Los Angeles arrested 20 people, including several members of an Orange County, Calif., street gang, on charges of bilking Medicare through phony billings for power wheelchairs, hospital beds and orthotic devices. Later that month federal authorities in Texas unsealed indictments against six Houston-area residents on similar charges.

Those efforts and others paid off, literally: The Justice Dept. reported last year that about two-thirds of the $2.4 billion it collected from false claims prosecutions during fiscal 2009 were healthcare-related.

Sebelius and Holder want to take things further. In the letter to state AGs, the duo set the goal of cutting the improper payment rate (a measure of fraud and waste in the Medicare Fee for Service program) in half by 2012. A series of regional fraud prevention “summits” will be convened over the next few months, along with regular meetings for the task force “to facilitate the exchange of information with partners in the public and private sector, and to help coordinate anti-fraud effort.”

HHS also plans to double the size of its Senior Medicare Patrol and “put more boots on the ground in the fight against Medicare fraud,” according to the letter. Finally, the agency will launch a media campaign this summer aimed at educating Medicare recipients on protecting against fraud.

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