Medicare Fraud Strike Force Rolling Into a City Near You

On May 20, 2009, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder announced the Health Care Fraud Prevention and Enforcement Action Team (HEAT), an interagency effort aimed at detecting and preventing fraud in Medicare and Medicaid. HEAT goals include (1) increasing training for providers on Medicare compliance; (2) improving data-sharing between CMS and law enforcement; and (3) strengthening program integrity activities to monitor and ensure Medicare Parts C and D compliance and enforcement. In addition, HEAT will continue current efforts focusing on suppliers of durable medical equipment. To aid these and other efforts to combat healthcare fraud, President Obama’s administration has included $311 million in its proposed FY 2010 budget, a 50 percent increase in funding from FY 2009. Please see the May 14, 2009, issue of the Health Law Update.

Additionally, the Attorney General and HHS Secretary announced the existing HHS-Department of Justice (DOJ) Medicare Fraud Strike Force teams in Southern Florida and Los Angeles will be expanded to Houston and Detroit. The Strike Force teams, including HHS and DOJ staff members, law enforcement agents and prosecutors, enforce Medicare fraud compliance on a targeted local level. Since its inception in 2007, the Medicare Fraud Strike Force team operating in Southern Florida has convicted 146 defendants and secured $186 million in criminal fines and civil recoveries. Providers need to keep an eye on the door for these expanding Strike Force teams.