Ongoing Efforts to Fight Health Care Fraud

by Tracy Russo

May 14, 2010 - Today, Acting Deputy Attorney General Gary G. Grindler spoke at The American Bar Association’s 20th Annual National Institute on Health Care Fraud. In his remarks, he outlined the cost of health care fraud and the comprehensive steps we are taking to combat health care fraud.

Acting Deputy Attorney General Grindler:

Every year, hundreds of billions of dollars are spent to provide health care for millions of American seniors, children and the disabled. And each year billions of these dollars, taxpayer dollars, are stolen through fraudulent schemes.

Combined federal and state spending on Medicaid and Medicare is projected to exceed 800 billion per year in 2010. While there is no official federal estimate of the level of fraud in Medicare, Medicaid or the healthcare sector more generally, external estimates project the amount at three to ten percent of total spending, that could correlate to $27 to $80 billion in 2010 alone, if left unchecked.

Not only does healthcare fraud threaten the economic stability of the healthcare system, it also drives up the cost of health care, insurance premiums and taxes for all Americans…

Last May, Attorney General Holder and Secretary Sebelius announced the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) which is a senior-level, joint task force, that I oversee along with my HHS counterpart, Deputy Secretary of HHS William Corr. HEAT was created to marshal the combined resources of both agencies in new ways to combat all facets of the health care fraud problem.

The high-level goals of the HEAT initiative are clear:

•To prevent and detect fraud;

•To strengthen enforcement efforts;

•To leverage partnerships through private sector outreach and better coordination with state and local anti-fraud efforts; and

•To provide more effective legal authorities by identifying and eliminating statutory and regulatory impediments to our health care fraud prevention and enforcement efforts.

We have had some remarkable successes thus far in working towards each of these goals. In fact, later this afternoon in Washington D.C., HHS and DOJ will be releasing the most recent HCFAC Report which details the results of our health care fraud prevention and enforcement efforts for Congress. The 2009 Report shows that:

•During Fiscal Year 2009 alone, the Department of Justice won or negotiated approximately $1.63 billion in judgments and settlements.

•Opened over 1000 new criminal health care fraud investigations.

•And convicted more than 580 defendants for health care fraud related crimes.

With the passage of the healthcare reform legislation we are confident that we will be even more successful in the future.