Health Care Fraud Prevention and Enforcement Efforts Result in Record Breaking Recoveries Totaling Nearly $4.1 Billion in 2011

Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in the 2011 Fiscal year. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.

These findings were released in the annual Health Care Fraud and Abuse Control Program (HCFAC) and are a direct result of President Obama making the elimination of fraud, waste and abuse a top priority in his administration. The success of this joint effort would not be possible without the Health Care Fraud Prevention & Enforcement Action Team (HEAT), which was created in 2009 to prevent fraud, waste and abuse in the Medicare and Medicaid Programs. Their efforts to crack down on the perpetrators who are abusing the system and costing millions of American taxpayers billions of dollars has been quite successful.

“This report reflects unprecedented successes by the Departments of Justice and HHS in aggressively preventing and combating health care fraud, safeguarding precious taxpayer dollars and ensuring the strength of our essential health care programs,” said Attorney General Holder. ” We are committed to the ongoing pursuit of accountability and helping the American people at a time when budgets are tight.”

CMS Daily Digest Bulletin

IT’S ABOUT TIME!. The above report demonstrates just how much fraud, waste and abuse exists. Not all health care providers are unscrupulous—many are. Therefore, it is vitally important that you arm yourself with good advice. You can do this by educating yourself about your health plan options, as well as your benefits and responsibilities.

Do you know what your Out-of-Pocket-Expenses will be for 2012? Do you know what Medicare pays vs. what you are responsible for financially? Take a minute to ask yourself how much you spent on your health care costs last year. Do you think that it will be the same for 2012? It might not be. Medicare has made quite a few changes for 2012. An increase in your Part A & Part D deductibles could have an impact on your healthcare costs.

How has Medicare and the newly developed fraud prevention programs been so successful? It’s actually quite brilliant, but simple in its origin. During 2011, Health Care Fraud Prevention & Enforcement Action Team (HEAT) and the Medicare Fraud Strike Force expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud. The departments hosted a series of regional fraud prevention summits across the country, provided free compliance training for providers and other stakeholders, and sent letters to state attorneys general urging them to work with the Department of Health and Human Services (HHS). Additionally, federal, state, and local law enforcement officials mounted a substantial outreach campaign to educate seniors. Such community-based fraud prevention programs have brought awareness to the Medicare community and Medicare healthcare providers alike.

The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes along with chronic fraud by deceitful individuals masquerading as health care providers or suppliers. In 2011 alone, strike force operations charged a record 323 defendants, who allegedly billed the Medicare program more than $ 1 billion. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 to prison. With their help, federal prosecutors were able to file criminal charges against a total of 1,430 defendants for health care fraud related crimes…”Fighting fraud is one of our top priorities and we have recovered an unprecedented number of taxpayer dollars,” said Secretary Sebelius. ” Our efforts strengthen the integrity of our health care programs, and meet the President’s call for a return to American values that ensure everyone gets a fair shot, everyone does their fair share, and everyone plays by the same rules.”

CMS Daily Digest Bulletin

The federal government, along with the Centers for Medicare and Medicaid Services (CMS) has made substantial improvements in cracking down on Medicare/Medicaid fraud and abuse, but it is still not enough. We applaud them for their efforts. With 80 million seniors turning 65 over the next twenty years, their efforts are still very much in demand. As the number of beneficiaries grows, their job becomes even more necessary and important. We can participate in this effort by educating others and ourselves about how to understand and thus make better health plan decisions.

Managed Care Consultants can be your educational partner and informational resource. There is no selling of any kind. We provide you the forum to ask your questions and get answers from Qualified Licensed Health Plan Professionals. We seek to understand your needs and provide clarity in the sometimes-confusing world of senior health plans. We work for you, not the health plan provider. Contact Calvert Louden at

By Managed Care Consultants Posted in Medicare

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