DOJ, HHS Combine Forces to Combat Fraud; DME a Target

WASHINGTON–The Department of Justice and the Department of
Health and Human Services are joining forces to combat Medicare and
Medicaid fraud, they announced Wednesday, and one of their first
efforts will be to target durable medical equipment
fraud.           

 
Attorney General Eric Holder and Department of Health and Human
Services Secretary Kathleen Sebelius said they will expand the
current DME anti-fraud operation in South Florida and Los Angeles
to Detroit and Houston.
 
In addition, Holder and Sebelius said they have formed the Health
Care Fraud and Prevention and Enforcement Action Team, which will
concentrate on coordinating federal and state efforts to crack down
on both Medicare and Medicaid fraud.
 
Members of HEAT will include officials of both agencies, state
Medicaid Fraud Control units and local police agencies, the
officials said.
 
“With this announcement, we raise the stakes on health care
fraud by launching a new effort with increased tools, resources and
a sustained focus by senior-level leadership,” Holder said in
a press release.
 
Sebelius acknowledged that the majority of DME providers adhere to
the law. “Most providers are doing the right thing and
providing care with integrity,” she said. “But we
cannot and will not allow billions of dollars to be stolen from
Medicare and Medicaid through fraud, waste and serious abuse of the
system. It’s time to bring the fight against fraud into the
21st century and put the resources on the streets and out into the
community to protect the American taxpayers and lower the cost of
health care.”
 
In addition to expanding the anti-fraud strike force project to
Detroit and Houston, officials said they will also build on the
Centers for Medicare and Medicaid Services’ demonstration
project in South Florida that requires site visits to potential DME
suppliers to ensure their legitimacy.
 
The two agencies will also increase Medicare compliance training
for providers, beef up data sharing between CMS and law enforcement
and boost monitoring of Medicare Parts C and D to ensure
compliance.
 
According to a BNA Health Care Daily report, the agencies will use
funds from the Health Care Fraud and Abuse Control account to fund
their work, supplemented by existing agency appropriations. Another
$311 million will come from increased funding for Medicare and
Medicaid oversight that is included in the president’s 2010
budget, Sebelius said.
 
BNA also reported that Assistant Attorney General Lanny Breuer told
the Senate Judiciary Subcommittee on Crimes and Drugs on Wednesday
that DME claim submissions to Medicare have dropped $1.75 billion
and actual DME payments have fallen by $334 million since the
strike force began operating in South Florida two years ago.
 
Holder and Sebelius also urged the American people to visit a new
Web site www.hhs.gov/stopmedicarefraud or
call 800/HHS-TIPS (800/447-8477) to report suspected Medicare
fraud.