Fighting health care fraud pays dividends
Today, our departments released a report showing that the Obama Administration's historic efforts to go after criminals who steal from Medicare and Medicaid are paying off, especially in hotspots like Houston.
The report shows that last year, we recovered a record $4.2 billion from those who prey on our health care system. In total, our efforts returned $14.9 billion over the last four years, more than double what was returned in the previous four years.
These accomplishments were made possible because the president has made fighting health care fraud a top priority.
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Over the past four years, we've strengthened coordination between our departments and law enforcement. The president's health care law has allowed us to place a record number of boots on the ground to catch those seeking to game our health care system for personal gain. And through a combination of tougher criminal sentences and record civil recoveries, we have effectively deterred countless others from engaging in such conduct, saving taxpayers from immeasurable losses.
We're making particular progress in the fight against health care fraud in cities like Houston, where the former co-owners of a home health care company were sentenced to nine years in prison for their participation in a $5.2 million scheme to swindle Medicare.
They paid co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims for care that was medically unnecessary or not provided. So far, nine people, including nurses and patient recruiters, have been sentenced in the scheme.
We've also put in place cutting-edge technology that lets us identify and respond to fraud faster. In the past, we were often two or three steps behind perpetrators, quickly paying out claims, only to have to go track down the bad guys after the fraud was discovered. That meant we were often showing up after criminals had already skipped town.
Thanks to new laws, including the health care law, we now have systems that can identify suspicious claims in real time, taking away the criminals' head start. Using technology similar to what credit card companies use to freeze accounts with suspicious purchases, we can now suspend suspicious payments before they go out. In the first year alone, this has led to 536 new investigations. And because the system is designed to get smarter over time, it's only going to be more effective in the future.
The health care law has also allowed us to establish a tougher screening process for providers in the areas where fraud is most likely to occur, such as home health visits or medical equipment like wheelchairs, which keeps bad actors from ever getting into the system.
And we've enacted some common sense safeguards and improved communication from program to program to stamp out fraud from the system. For example, if providers and suppliers of medical goods get terminated from one state's Medicaid program or Medicare, all Medicaid programs are now notified. You can no longer simply move from state to state, pursuing the same scam. We've also eliminated nearly 150,000 ineligible providers from Medicare, reducing opportunities for bad actors to submit fraudulent bills.
The bottom line is simple. For someone thinking about committing fraud, today's landscape looks a lot more daunting than it has for years. It's harder than ever to get into the system as a bad actor. If they do get in, it's harder still to submit a fraudulent claim. If they find a way to submit a claim, they're going to get caught. And when they're caught, they're going to face a tougher punishment.
The Obama administration takes nothing more seriously than our responsibility to protect taxpayer dollars and use them wisely, especially when those dollars support important programs like Medicare and Medicaid.
These are the programs that ensure that kids can get their checkups, moms can have healthy pregnancies, people with disabilities can live with dignity, and seniors don't have to worry about going broke because of a hospital bill.
That's why we're proud that over the last three years, the government recovered a record $7.90 for every $1 we've invested, allowing us to provide better care to beneficiaries and strengthen our health care programs for future generations.
Our ultimate goal is to prevent a single dollar from going to waste. And today's report shows that we're moving in the right direction.
Holder is the attorney general of the United States. Sebelius is secretary of health and human services.