Feds recover $4.1B in health care fraud in 2011

Benefits pro reports:

“MIAMI (AP) — Federal authorities say they recovered $4.1 billion in health care fraud judgments last year, a record high which officials on Monday credited to new tools for cracking down on deceitful Medicare claims.

The recovered funds are up roughly 50 percent from 2009. Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius were expected to make the announcement at a news conference Tuesday.

The Department of Justice and the Department of Health and Human Services told The Associated Press that agencies are doing a better job of screening providers before they get in the system and have beefed up enrollment requirements. Now investigators are conducting site visits to make sure moderate risk providers have a legitimate office. Higher risk providers are also subject to fingerprint and criminal background checks.

Authorities have long said the solution to solving the nation’s estimated $60 billion to $90 billion a year Medicare fraud problem lies in vigorously screening providers and stopping payment to suspicious ones.

They also say it is important to end the antiquated system of paying the claims then chasing suspicious ones. By the time officials catch on to bogus billing patterns, crooks typically dump that provider ID and open a new one, or flee the country. The Centers for Medicare and Medicaid Services has come under fire for lax screening as violent criminals and mobsters are also getting involved, seeing the fraud as more lucrative than dealing drugs and having less severe criminal penalties.

Halting Medicare fraud has become even more paramount as the scams that once bilked $1 million or $2 million a decade ago have morphed into sophisticated multimillion dollar networks involving doctors, patient recruiters and patients.

“Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” Sebelius said in a statement. “Our efforts strengthen the integrity of our health care programs, and meet the president’s call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules.”

Federal health officials said Monday they are also doing a better job of sharing data with other agencies.

Officials credited the spike in recovered funds in part to strike force teams set up in fraud hot spots around the country, including Miami, Detroit and Los Angeles.

The teams charged 323 defendants, who collectively billed the Medicare program more than $1 billion last year. That includes a massive bust in February 2011, in which more than 100 doctors, nurses and physical therapists were charged with fraud in nine states. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul.

“These efforts reflect a strong, ongoing commitment to fiscal accountability and to helping the American people at a time when budgets are tight,” Holder said in a statement.

Department of Justice officials also noted that judges are sending a message by doling out longer sentences. The average prison sentence in fraud cases was more than 47 months in 2011, compared to 42 months the previous year.”