- Shawn Henry
- Executive Assistant Director
- Federal Bureau of Investigation
- HEAT/Strike Force Health Care Fraud Press Availability
- Washington, D.C.
- February 17, 2011
Good afternoon. As the Attorney General and Secretary Sebelius have noted, health care fraud impacts all Americans.
You may never directly encounter health care fraud, but you will feel the financial impact. The effect is much the same as a pickpocket. You’ll just feel the pinch in a different way, with higher health care costs, higher insurance premiums, and more expensive prescription drugs.
Those who commit health care fraud may operate in various jurisdictions; they certainly run different schemes. But they share one common misconception: that Medicare funds are free for the taking.
Just as we are sharing information to stop health care fraud, criminals are sharing information to further their own ends. We’re increasingly seeing organized crime groups move into health care fraud because of its profitability.
They’re sharing novel ways to steal money and avoid detection. For example, recruiters are targeting low-income areas and soup kitchens to find new patients. They’ll approach a potential target, saying, “If you’ve got a red-white-and-blue card (a Medicare card), I’ll give you 50 bucks.” They’ll have the fake patient sign a few forms or briefly see a doctor, and then pocket a hundred dollars themselves.
They are providing services that might appear legitimate, but that may be unnecessary, ineffective, or billed incorrectly. They are savvy to health care rules and regulations and they know how to evade them, avoid them, and exploit them. And there is no competition because, in their minds, Medicare is a bottomless pot of gold.
Outside estimates of Medicare and Medicaid fraud are in the billions of dollars annually.
As the Attorney General said, the HEAT strike forces are key to stopping the raiding of our health care resources. But that’s not all we’re doing to fight this fraud. In addition to the HEAT strike forces, the FBI has health care fraud task forces and working groups across the country. We are investigating more than 2,600 cases of health care fraud.
Agents and analysts are using intelligence to identify emerging schemes and techniques to help prevent and mitigate the threat. And we use all the weapons in our arsenal to combat it.
We are using undercover operations and wiretaps—not only to collect evidence for prosecution, but to cut off the heads of these criminal enterprises so they cannot flourish elsewhere.
We’ve dismantled dozens of criminal enterprises engaged in widespread health care fraud, and sought seizures and forfeitures to recover program funds.
The FBI is proud to be a part of this effort, with the opportunity to work with the Department of Health and Human Services Office of Inspector General and other partners in every one of our field offices.
Last year, with our law enforcement partners, we charged approximately 930 individuals in health care fraud cases, and obtained nearly 750 convictions. Our investigations and prosecutions returned more than $4 billion to the U.S. Treasury and other victims of this fraud.
Our partnerships with other agencies are a critical piece of our strategy. And today’s takedown is the result of strong partnership at all levels. But our work is not done.
The health care system is a critical piece of our nation’s infrastructure. We will continue to work together to protect the integrity of Medicare and our health care system at large.
But law enforcement is only part of the solution. We need the help of Medicare and Medicaid beneficiaries. And since many of those who participate in these programs are elderly, we need the help of their sons and daughters.
Your explanation of benefits is your first line of defense. Review that document carefully to make sure it reflects the services you are being billed for. If you suspect fraud, call your local FBI office or the HHS Office of Inspector General.
And treat your Medicare card like you would a credit card. Protect the information on it to keep it from being misused.
The costs of health care fraud are ultimately borne by all of us—the U.S. taxpayers.
Working together, we can help thwart criminals who seek to steal taxpayer dollars to line their own pockets and we can help ensure that our nation’s health care system is there for those who need it.