HHS to scammers: Don't even think about Medicare fraud

As the government celebrates a year of unprecedented, record-breaking healthcare fraud recoveries, the U.S. Department of Health & Human Services and the Justice Department are sending a message to potential fraudsters: "Don't even try," HHS Secretary Kathleen Sebelius said yesterday at a Chicago summit.

The agencies are putting money where their mouths are, implementing new tools, resources and authorities to strengthen fraud prevention and enforcement efforts. For instance, the government is applying tougher penalties for healthcare fraud, with criminals facing 20 to 50 percent longer sentences for crimes involving more than $1 million in losses, according to a statement.

The government also is enhancing its anti-fraud activity with last month's release of a new, user-friendly billing statement that makes it easier for patients to detect fraudulent Medicare charges, as well as lets them know about monetary rewards given in exchange for information.

Other new tools to discourage potential healthcare fraud include:

  • Increased coordination and information sharing between the Centers for Medicare & Medicaid Services and the Office of the Inspector General
  • Expansion of the recovery audit contractor program to police for waste, fraud and abuse in Medicaid, Medicare Advantage and Medicare Part D programs
  • State-of-the-art technology that reviews claims before they are paid to better monitor fraud trends and identify suspicious behavior and billing irregularities

"Thanks to health reform and our Administration's work, we have new tools and resources to catch criminals and stop Medicare fraud before it happens," Sebelius said.

On top of the nearly $4.1 billion in recovered judgments in fiscal year 2011, federal prosecutions of healthcare fraud soared, jumping about 75 percent from 797 in fiscal year 2008 to 1,430 in 2011, according to the statement.

To learn more:
- read the HHS statement
- check out all the new fraud prevention tools