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Kathleen Sebelius, Secretary of Health and Human Services, and Attorney General Eric Holder in a news release issued yesterday from HHS said the new law would build on the success of current joint Department of Justice and HHS fraud fighting efforts like the HEAT Task Force.


The annual Health Care Fraud and Abuse Control Program (HCFAC) Report released Thursday by both Departments showed that innovative strategies to protect consumers helped prevent fraud and recover billions of dollars for taxpayers in 2009.


In addition to strengthening law enforcement capabilities, the new law also is intended to help shift the emphasis from the old model of “pay and chase” to a new model that puts a premium on fraud prevention and program integrity. HHS will be working with the Department of Justice and the newly created Center for Program Integrity (CPI) at the Center for Medicare and Medicaid Services to build on the success of the HEAT Task Force and aggressively fight fraud in order to ensure that the full benefits of the new law reach American families, according to the published news release.


The Affordable Care Act is intended to target resources to areas where fraud and abuse are greatest, coordinates and consolidates fraud-fighting efforts across Medicare and Medicaid, and would expand the partnership with the private sector to help stamp out waste and fraud and protect consumers.


According to the news release, the HCFAC report showed significant progress in fighting fraud.  In fiscal year 2009, anti-fraud efforts resulted in $2.51 billion being deposited to the Medicare Trust Fund, a $569 million, or 29 percent, increase over FY 2008.  In addition, over $441 million in federal Medicaid money was returned to the Treasury, a 28 percent increase from FY 2008.


The Affordable Care Act is expected to build on innovative strategies to fight fraud, such as Project HEAT, the joint operation between DOJ, CMS and the HHS Office of Inspector General that has unleashed special strike forces in six states to target  health care fraud hot spots like South Florida, New York, Texas, California, Louisiana and Michigan, according to the news release.


Officials at both the DOJ and HHS stressed that the expanded law enforcement efforts would be supported by the newly established Center for Program Integrity at the Centers for Medicare & Medicaid Services, which would use state-of-the-art methods to implement provisions of the Affordable Care Act that detect fraud and prevent improper payments. The Center would also work with the private health care sector to better target fraud and abuse.

For more information on the 2009 Health Care Fraud and Abuse Control Program Report, please visit http://www.aging.com/medicare-enrollment-guide/




Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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