Acting DAG Grindler addresses healthcare fraud at state AG meeting

by Ben Vernia | June 14th, 2010

In remarks delivered on June 14 at the National Association of Attorneys General meeting in Seattle, Acting Deputy Attorney General Gary Grindler spoke on three topics: financial fraud, healthcare fraud, and child exploitaiton. Here are his comments on healthcare fraud:

Second, there is another breed of fraud, also pervasive, also destructive, that can be more effectively handled through partnership. I am, of course, referring to health care fraud, something for which all of us can agree the government must have zero tolerance.

Some say health care fraud is victimless, but that could not be farther from the truth. Nearly every American, whether covered by Medicare, Medicaid, or one of the many victimized private insurers, has been affected by this self-serving crime. Every year hundreds of billions of federal dollars are spent to provide health security for American seniors, children, and the disabled. And while most medical or pharmaceutical providers do the right thing, when Medicare or Medicaid fraud does occur, it costs the American taxpayer billions that could be spent on patient care, and in that sense, it not only raises taxes and insurance premiums; it harms the stability of public health care programs; and threatens the quality of care in our nation’s doctors’ offices and hospitals.

The numbers are staggering – and unacceptable.

As the combined spending on Medicare and Medicaid has more than doubled over the past decade and it’s projected to exceed $800 billion this year. Fraud has also increased; external estimates project the fraud accounts for three to ten percent of total spending. That’s between $27 and $80 billion.

But you know this is an issue already. So many of you are engaged in Medicare Fraud Strike Forces, and your close working relationship with the National Association of Medicaid Fraud Control Units facilitates the kind of teamwork, sharing, and critical enforcement cooperation that it takes to curb a crime that sometimes appears to know no limits.

We, too, at the Department of Justice have met the crisis with a strong response: the Health Care Fraud Prevention and Enforcement Action Team, or HEAT. HEAT is another historic coalition that reaches across departments, both the Departments of Justice and Health and Human Services, and across law enforcement agencies. The purpose is both to prevent fraud, waste and abuse before it happens, and to aggressively combat it if, and when, it occurs.

On the federal level, that means many things – increasing prepayment reviews, audits, site visits, real-time sharing of claims data, for example, and employing more effective anti-fraud audits – but it also means a great deal for you, our state partners: greater opportunities for coordination, expanded use of Medicare Fraud Strike Forces, and broader state authority to respond appropriately to health care fraud when it occurs.

As I can see every day in my role as supervisor of the Justice Department’s day-to-day health care fraud prevention efforts, it’s working. HEAT’s targeted, data-driven criminal enforcement strategy in key geographic locations – using the Medicare Strike Force teams driven in large part by many of you – has already had a major impact on deterring fraud and abuse, protecting patients and the elderly from scams, and ensuring those who steal taxpayer funds are held fully accountable, as they must be.

Since the announcement of HEAT last May, Strike Force prosecutors have successfully prosecuted hundreds of individuals and secured judgments worth over a billion dollars.

In addition to the federal Task Forces, HEAT is also working to assist you. Just last week Attorney General Holder and Secretary Sebelius reached out to all of you regarding the most recent HEAT initiatives and to identify some areas for increased partnership.

First, following on the National Health Care Fraud Summit that was hosted in Washington, D.C. earlier this year, the President has asked the Department of Justice and HHS to convene a series of regional fraud prevention summits around the country over the next few months. The first summit will take place in Miami on July 16. Other summits will follow in, for example, Los Angeles, Las Vegas, Detroit, Boston, New York, and Philadelphia.

These summits will bring together representatives from federal, state, and local law enforcement agencies, representatives from the private sector including healthcare providers, hospitals, and doctors to share information about trends in health care fraud and to ensure effective referral mechanisms and procedures for joint investigations. Your expertise and experience will be key to the success of these events.

Second, I sent a memo to every United States Attorney in the country asking them to convene regular health care fraud task force meetings to facilitate the exchange of information with partners in the public and private sector, and to help coordinate ant-fraud efforts. Most of these meetings will be held quarterly and all of the U.S. Attorneys have been asked to schedule the first meeting by August 16, 2010. I hope that you and your office will take part in these regular exchanges.

Third, HHS will be doubling the size of the Senior Medicare Patrol which recruits and trains retired professionals and other senior citizens about how to recognize and report instances or patterns of health care fraud. Close to 3 million Medicare beneficiaries have been educated since the start of the program in 1997, and currently the Senior Medicare Patrol program funds projects in every state, the District of Columbia, Puerto Rico, Guam, and the Virginia Islands.

Still, we can do even more.

And legally speaking, more can be done, thanks to the Patient Protection and Affordable Care Act passed earlier this year. In addition to creating new, powerful tools for the federal government in its fight against health care fraud, the heath care reform law provides new access to Medicaid data for the Secretary of HHS that will assist states in coordinating anti-fraud activities, giving them greater incentive and flexibility in identifying and collecting Medicaid overpayments.

And under the new law, states now have stronger authority to suspend payments to providers suspected of fraud, to place providers of high-risk categories of service under provisional increased oversight, and to impose moratoria on the enrollment of certain types of providers. Even if you haven’t felt the effect of these tools quite yet, they will, I’m confident, prove indispensable to each of you in the weeks, months, and years ahead.

In the end, all of these efforts, I believe, go to our basic duty to citizens in every state to ensure their hard-earned tax dollars are spent for the benefit of those who need medical care, not those who seek to enrich themselves at the expense of others. And so we welcome your ideas; your expertise; and, in the best traditions of this association, your active partnership in fulfilling our common duty to address this ongoing threat.

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