Report: Efforts To Fight Medicare Fraud Brought in Billions Last Year

Efforts by the federal government to eliminate Medicare fraud have produced $2.5 billion for the program's trust fund in fiscal year 2009, a 29% increase from the previous year, according to a report released on Thursday by HHS Secretary Kathleen Sebelius and Attorney General Eric Holder, CQ HealthBeat reports.

The report also found that $441 million was returned to the Medicaid program because of anti-fraud efforts, an increase of 28% over the 2008 amount.

According to the report, the U.S. convicted 583 defendants for crimes related to health care fraud in 2009 (Norman, CQ HealthBeat, 5/13). The federal government also won or negotiated $1.63 billion in judgments and settlements, the report found (Yost, AP/San Francisco Chronicle, 5/13).

In addition, U.S. attorneys offices opened 1,014 new criminal health care fraud investigations with 1,786 potential defendants in 2009, according to the report.

Health Reform Law Could Boost Anti-Fraud Efforts

Holder and Sebelius said that the new health reform law could bolster future efforts to address fraud within Medicare. The overhaul allocates $600 million over 10 years for such efforts (CQ HealthBeat, 5/13).

The overhaul stipulates that health care providers could be subject to fingerprinting, site visits and criminal background checks before they are permitted to bill Medicare and Medicaid.

The new reform law also allows HHS to withhold payments to Medicare or Medicaid providers if an investigation is pending and lengthen prison sentences for U.S. residents convicted of health care fraud (AP/San Francisco Chronicle, 5/13).

HHS and the Department of Justice plan to implement anti-fraud provisions in the law through a new Medicare program called the Center for Program Integrity (CQ HealthBeat, 5/13).

HHS and DOJ officials said that they are putting investigative resources in areas of widespread health care fraud, including Baton Rouge, La.; Brooklyn, N.Y.; Detroit; south Florida; Houston; Los Angeles; and Tampa, Fla. (AP/San Francisco Chronicle, 5/13).