The U.S. Attorney General and HHS will apply anti-crime methods -- used to fight Medicare fraud in Los Angeles and Miami -- to Houston and Detroit, officials announced May 20. Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced the Health Care Fraud Prevention and Enforcement Action Team (HEAT) will target those cities, but no timeframe was given in a statement sent out to reporters.
"Prevention is critical to reforming the system and the HEAT team will also focus critical resources on preventing fraud from occurring in the first place," the statement said. "The team will build on demonstration projects by the HHS Inspector General and [CMS] that focus on suppliers of durable medical equipment (DME). These projects increase site visits to potential suppliers to prevent imposters from posing as legitimate DME providers."
Other initiatives include:
- Increasing training for providers on Medicare compliance, offering providers the resources and the knowledge they need to help identify and prevent fraud.
- Improving data sharing between CMS and law enforcement so we can identify patterns that lead to fraud.
- Strengthening program integrity activities to monitor and ensure Medicare Parts C (Medicare Advantage plans) and D (prescription drug programs) compliance and enforcement.
According to the release, a Medicare Fraud Strike Force team operating in South Florida has already convicted 146 defendants and secured $186 million in criminal fines and civil recoveries. The strike force was implemented in Los Angeles in 2008 where 37 defendants have been charged with fraud and more than $55 million has been ordered in restitution to the Medicare program.