Attorney General Holder and Secretary Sebelius Team Up at Health Care Fraud Prevention Summit in Boston
Massachusetts Home to the Largest Health Care Fraud Settlement in History
|U.S. Department of Justice December 16, 2010|
WASHINGTON—As part of the Obama Administration’s ongoing efforts to prevent and fight fraud in our nation’s healthcare system, Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen Sebelius visited Boston today, where they participated in the fourth Regional Health Care Fraud Prevention Summit. The summit brings together a wide array of federal, state, and local partners, beneficiaries, providers, and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system.
In the District of Massachusetts, the Department of Justice has recovered more than $4 billion in civil and criminal health care fraud settlements over the past two years, including the $2.3 billion settlement with Pfizer Inc. in September 2009—the largest health care fraud settlement in history.
“Here in Boston and in communities across the country, health care fraud schemes are being aggressively and permanently shut down. The District of Massachusetts, with U.S. Attorney Carmen Ortiz at its helm, has recovered more than $4 billion in civil and criminal health care fraud settlements over the past two years,” said Attorney General Eric Holder. “These actions are in large part because of the great work being led by Health Care Fraud Prevention and Enforcement Action Team (HEAT). Through this initiative, we are working in partnership with government, law enforcement and industry leaders to protect taxpayer dollars, control health care costs, and ensure the strength and integrity of our most essential health care programs. Simply put, we have taken our fight against health case fraud to a new level, and I am committed to continued collaboration, vigilance, and progress.”
“This has been a remarkable year for cracking down on health care fraud—and our success has been built on initiatives like these combining the experience and insight of our law enforcement teams with new resources and cutting-edge technology,” said Secretary Sebelius. “Thanks to the new tools and resources provided under the Affordable Care Act, we are more effective at going after the fraudsters that are stealing taxpayer dollars.”
Joining Attorney General Holder and Secretary Sebelius at the University of Massachusetts-Boston, were Assistant Attorney General Tony West of the Civil Division and U.S. Attorney Carmen Ortiz of the District of Massachusetts. The summit also featured four educational panels aimed at identifying best practices for providers, law enforcement and beneficiaries in preventing health care fraud.
The recently enacted Affordable Care Act provides additional tools and resources to fight fraud in the health care system by providing an additional $350 million over the next 10 years through the Health Care Fraud and Abuse Control Account. The Act toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across government, expands overpayment recovery efforts, and provides greater oversight of private insurance abuses. For information on the 2009 Health Care Fraud and Abuse Control Program Report, please visit: http://www.justice.gov/archive/dag/pubdoc/hcfacreport2009.pdf.
Investments in fraud detection and enforcement pay for themselves many times over, and the Administration’s tough stance against fraud is already yielding results. In FY 2009, anti-fraud efforts put $2.51 billion back in the Medicare Trust Fund resulting from civil recoveries, fines in criminal matters and administrative recoveries. This was a $569 million, or 29 percent, increase over FY 2008. In FY 2009, more than $441 million in federal Medicaid money was returned to the U.S. Treasury, a 28 percent increase from FY 2008. Most recently, in FY 2010, the Department of Justice obtained settlements and judgments of more than $2.5 billion in False Claims Act matters alleging health care fraud. This is highest amount ever obtained in a single year, up from $1.68 billion in FY 2009.
The summits are part of the overall joint health care fraud fighting effort undertaken jointly by the Department of Justice and the Department of Health and Human Services through HEAT. As one part of HEAT’s efforts, Medicare Fraud Strike Force operations have expanded from South Florida and Los Angeles to a total of seven health care fraud hot spots including Houston; Detroit.; Brooklyn, N.Y.; Baton Rouge, La.; and Tampa, Fla. The Strike Force is a partnership between the Criminal Division’s Fraud Section, U.S. Attorneys’ Offices, HHS’ Office of Inspector General, FBI and other federal, state and local law enforcement partners. Since their inception in March 2007, Medicare Fraud Strike Force operations have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 billion.
On June 8, 2010, President Obama announced this nationwide series of regional fraud prevention summits as part of a multi-faceted effort to crack down on health care fraud. The Boston summit was the fourth in a series, with additional summits to follow in the coming months in Detroit, Boston, Philadelphia and Las Vegas. Previous summits were held in Brooklyn (Nov. 5, 2010), Miami (July 16, 2010) and Los Angeles (Aug. 26, 2010).