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Health care law enhances ability to cut fraud, strengthen Medicare

By Kathleen Sebelius and Eric Holder

Long Beach Press-Telegram
May 13, 2012 

WE are proud to say that last week Los Angeles was part of the largest-ever coordinated law enforcement takedown of eight defendants charged with committing fraud against Medicare and Medicaid.

Medicare Fraud Strike Force teams in Los Angeles and six other cities, operated in partnership by the Department of Health and Human Services and the Department of Justice, charged 107 people with allegedly submitting fraudulent claims to Medicare worth about $450 million.

Since 2009, the Obama administration has more than quadrupled the number of Medicare Strike Force teams operating in fraud hot spots around the country. And the president's 2010 health care law, the Affordable Care Act, has put more boots on the ground and established tougher sentences for those who commit fraud. More than 500 law enforcement agents participated in the May 2 operation.

The health care law and other recent legislation have also enhanced our ability to put in place cutting-edge technology that makes it possible to identify and respond to fraud faster. In the past, government was often two or three steps behind the perpetrators, too often showing up after the criminals had already skipped town.

The Affordable Care Act and other recent legislation give us new data-analysis tools to look at trends across claims data, instead of monitoring each claim individually. Using a technology similar to what credit card companies use to identify and stop suspicious payments before they go out, we are using new authorities under the health care law to suspend payments when there are credible allegations of fraud until an investigation is complete.

The Centers for Medicare and Medicaid Services has stopped payment or taken other administrative actions on 52 provider organizations connected to the May 2 arrests until we have investigated them fully. Now, those looking to rip off Medicare aren't getting a head start.

The health care law also gives us the authority to put in place new safeguards to keep bad actors out of Medicare and Medicaid in the first place. For example, we've established a tougher screening process for the enrollment of providers in the areas where fraud is most likely to occur, such as for home health visits or durable medical equipment like wheelchairs.

In short, we have made it harder to submit a fraudulent Medicare claim. And criminals who do are more likely to get caught: the number of defendants in all criminal health care fraud cases increased by more than 75 percent during the Obama administration, from 797 in 2008 to 1,430 last year - and if convicted, criminals face longer jail sentences due to new sentencing guidelines.

This fight against fraud is a key part of this administration's effort to strengthen Medicare for the future. According to the Medicare actuaries, the Affordable Care Act - including some of its key anti-fraud provisions - has extended the life of the Medicare Trust Fund by eight years to 2024.

We are committed to continuing to strengthen Medicare and Medicaid and getting the criminals out of our health care system so that we can ensure that our seniors and other vulnerable citizens in Los Angeles and across the nation will have access to the high-quality, affordable health care that they need and deserve.