Administration officials testify on health care fraud before Senate Judiciary Committee

by bvernia | October 30th, 2009

On Wednesday, Civil Division Assistant Attorney General Tony West and HHS Deputy Secretary Bill Corr testified before the Senate Judiciary Committee on the Administration’s efforts to combat health care fraud. In prepared remarks, West described the overall DOJ effort, and detailed projects of the FBI and the Civil, Criminal, and Civil Rights Divisions.

Corr’s testimony was more detailed, and described the results of HHS’s implementation of several key anti-fraud programs, including: the creation of an Integrated Data Repository, which will centralize claims data, and permit CMS to identify suspicious patterns; the Medicaid Integrity Program, which provides dedicated funding for additional review, enforcement and educational resources; and the Medicare-Medicaid (Medi-Medi) Data Match Pilot Program. Corr also described HHS’s efforts to review the effectiveness of state Medicaid antifraud programs.

In his opening remarks (both written and as provided on this webcast), Judiciary chairman Sen. Leahy underscored the increased focus on health care fraud in light of the debate over health insurance reform. He made clear that additional resources would accompany that legislation:

I am glad that pending legislation would expand the Health Care Fraud and Abuse Control program, which funds our Federal anti-fraud efforts. This program has been a great success over the years, but it needs additional investigators and prosecutors to continue to fight health care fraud effectively. Since its creation in 1996, the program has recovered and restored to the Medicare Trust Fund more than $11 billion dollars lost to fraud. According to the Justice Department, every dollar spent on health care fraud enforcement returns four dollars to the U.S. Treasury. Estimates by independent, non-government entities suggest that the return is even greater. Investing more money in health care fraud enforcement is good policy and good economics.

In other highlights, Sen. Franken (see the webcast, at the 71:30 mark) bemoaned the Government’s failure to obtain prison sentences for health care fraud, providing the Pfizer case in 2009 as an example.

Sen Grassley asked West why DOJ (see the webcast at 63:00) had not yet delegated authority to issue Civil Investigative Demands to officials lower than the Attorney General, as the 2009 FCA amendments permitted. AAG West stated that DOJ “welcomed” the amendment, and said it was “moving through the internal DOJ process,” but he declined to say when this would happen. He also declined to say whether DOJ would delegate CID authority to the level of US Attorneys.

Grassley also took the opportunity to complain again (see the webcast, at 67:30) about the backlog of qui tam suits. He stated that there were 1040 cases still under seal (985 of which are health care fraud cases), compared to 130 in which the US has intervened and another 340 in which DOJ has declined. AAG West stated that he had looked into this issue shortly after arriving at DOJ, and that the cases were being actively investigated, but that some remained under seal due to parallel criminal investigations, and to conduct global settlement negotiations with defendants.

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