Obama Administration’s Unprecedented Fraud Fighting Pays Off

By Kathleen Sebelius, Secretary of Health and Human Services
Posted February 14, 2012

More than most seniors, Jacqueline Jefferson of Philadelphia, PA, knows that bad actors looking to defraud Medicare have lots of tricks up their sleeves – and persistence.

Seven years ago, Jacqueline was reviewing her Medicare medical statement and noticed a number of false charges. She did the right thing and alerted Medicare.  She also realized that many of her fellow Medicare patients may not know they are at risk for fraud – or may be afraid to step forward. The experience inspired her to join the Senior Medicare Patrol (SMP) – a group of senior citizen volunteers who educate and empower their peers to identify, prevent and report health care fraud. 

Thanks to the Obama Administration, funding for the SMP has increased by 75 percent from FY 2008 to FY 2011 . In 2010, nearly 5,000 volunteers helped educate about 300,000 Medicare patients at 8,300 community anti-fraud events.  And those volunteers held more than 70,000 one-on-one counseling sessions on potential Medicare fraud, waste or abuse cases – more than double the number in 2009.

That’s a good thing – because, like many seniors, Jacqueline was the target of yet another fraud attempt.  She was contacted multiple times by telemarketers offering free diabetic supplies in exchange for her Medicare number – even though she isn’t a diabetic. You can see her story here.

These efforts are part of the unprecedented focus the Obama Administration has brought to both stopping fraud before it happens, and recovering fraudulent Medicare payments and prosecuting fraudsters.

Today, the Departments of Justice and Health and Human Services (HHS) released an updated annual report showing that, for the second year in a row, anti-fraud efforts have recovered more than $4.1 billion in fraudulent Medicare payments.  Compare this to just $2.14 billion recovered in FY 2008.  Prosecutions are way up too:  the number of individuals charged with fraud increased from 821 in fiscal year 2008 to 1,430 in fiscal year 2011 – nearly a 75 percent increase.

The Obama Administration is doing more to stop fraud before it happens.  For example, before this Administration a fraudster could swindle Medicare for millions of dollars in Florida, close up shop, move to Detroit, and attempt to reestablish the same scheme without ever being noticed.  Now, CMS and  Department of Justice officials are tracking fraud scams as they move across the country, so that criminals are spotted when they try to re-enroll into Medicare or Medicaid.

This is just one of many new ways we’re working hard to protect taxpayer dollars from fraud.  Check out this fact sheet on how our work on fraud compares to the old rules and all the new tools the Affordable Care Act created to help fight fraud.