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Detroit Fraud Prevention Summit

March 15, 2011
Detroit, MI

Remarks as prepared for delivery

Thank you Attorney General Holder. It has been an honor to work with you and your terrific team at the Department of Justice in our fight to keep criminals out of the health care system.

I want to thank everyone for participating and for the important work you do every day to fight fraud on the front lines.

I look forward to hearing about the new ideas and partnerships that come out of today’s discussion.

I also want to recognize Deputy Administrator Peter Budetti, US Attorney Barbara McQuade, and Inspector General Dan Levinson.

As well as President Allan Gilmour, Dean Valerie Parisi and all of our hosts at Wayne State for opening their doors to us and making today’s gathering such a success.

It was a little more than year ago that Attorney General Holder and I convened the first National Health Care Fraud Summit in Maryland, bringing together law enforcement, health care providers, beneficiaries, and federal, state, and local officials to share best practices and develop new strategies in fraud prevention.

At the time, I said I hoped it wouldn’t be our last Summit, and over the last year we’ve made good on that promise in South Florida and Southern California, in Brooklyn and Boston.

That path has brought us here to Detroit and in the weeks ahead we will meet again in Philadelphia and Las Vegas – not just to continue the conversation, but to stay ahead of those who want to take advantage of our health care system.

Attorney General Holder highlighted the work of our strike teams in Detroit and across the nation. And we’ve recently seen their coordinated approach pay off in a number of record-breaking arrests.

You have heard about the Guillarte sisters, Clara and Caridad, and read about them in the Detroit Free Press last weekend.

They’ve been on the run and on the Inspector General’s Most Wanted List since we shut down their Dearborn infusion clinic for fraud.

I am proud to tell you today that, thanks to the joint efforts of our relentless OIG Agents and the FBI, the Guillarte sisters are now in federal custody. They were recently apprehended in South America and have just been brought back to US soil, touching down in Miami late last night where they were met by members of the Detroit Medicare fraud strike force.

Of course, there are more people like them out there. One thing we know about the criminals who commit fraud is that they are not complacent. They are always probing our health care system for its weak points and coming up with new schemes to exploit them.

So we’ve stepped up to take these criminals head on – to be just as active, just as creative, and just as coordinated.

As a result, the prospects for a criminal thinking about targeting our health care system today have gotten a lot gloomier.

The Guillarte sisters and their co-conspirators submitted 9.1 million dollars in false and fraudulent claims according to the Federal indictment.

But what if they were just getting started today?

It’s clear that they would have a lot tougher time getting their criminal enterprise off the ground.

Let me tell you why.

First of all, it would be a lot more difficult for them to enroll their facility as a Medicare and Medicaid provider.

Thanks to provisions in the Affordable Care Act, we’ve begun to implement front-end protections and tough provider screenings to keep bad actors out. It is suddenly a lot harder to simply hang up a shingle and start submitting claims.

We have also moved aggressively to establish competitive bidding among medical equipment suppliers of products like hospital beds and wheelchairs.

This kind of competition is projected to create an average savings of 32 percent – or about $28 billion dollars in lower out-of-pocket costs for consumers. It is also making some of the ripest targets a lot less appealing.

Of course even if criminals like the Guillarte sisters do find their way into the system, they will face a far greater chance of getting caught.

Instead of the old ‘pay and chase’ model, we’re getting proactive.

Late last year we issued a solicitation for state-of-the-art analytic tools to help predict and identify fraudulent claims as soon as they are submitted, so we can stop payment before it goes out the door.

These are the same type of predictive modeling tools that banks and insurance companies use to identify potential fraud before it occurs. They are how your credit card company can raise the alarm if they see a dozen flat-screen televisions charged to your card in one day.

At the same time we’re also making it easier for law enforcement officials from the FBI, the Inspector General Office’s and local jurisdictions to share data and access claims information in real time as soon as they are submitted to Medicare.

Under the old system, it was as if police officers in one town weren’t talking to the officers in the next town.

Now, we’re all beginning to plug into the same system in real time, so we can respond with the same speed and agility as the criminals who shift their schemes and locations to avoid detection.

Many of these new provisions are being implemented under the Affordable Care Act, which will celebrate its one year anniversary next week.

In just a short time, the health care law has already proven to be one of the toughest anti-fraud laws in American History.

And we will continue to implement the law’s latest regulations and work with law enforcement to make sure they have the tools to see the big picture and take down even the largest criminal enterprises.

At the end of the day though, no law or technology is as effective at preventing fraud as consumers who are educated and informed.

With the support of partner organizations across the country, thousands of Senior Medicare Patrol volunteers are giving their friends and neighbors the tools to recognize, resist, and report fraud.

Already, more than 3.84 million beneficiaries have taken advantage of the program’s one-on-one or group counseling sessions. And its community outreach events have reached almost 24 million people.

The Senior Medicare Patrol has proven to be such an effective ally in combating fraud that we are working to expand it. Our website, has the latest information for anyone interested in the Senior Medicare Patrol, including the brand new PSA you saw this morning.

Later today, we are hosting an event in Dearborn with ACCESS – the Arab Community Center for Economic and Community Services – which is reaching out to Arab communities across the region to highlight the work that everyone can do to help fight fraud.

And we are also working with providers who have a critical role to play in making sure their colleagues are trained and prepared to meet their legal and ethical responsibilities.

Our new publication, “A Roadmap for New Physicians,” has gone out to medical schools across the country.

Altogether these efforts are making a real difference. We are honoring our commitment to America’s seniors, meeting our obligation to taxpayers, and standing up to criminals who, in the past, have gotten away with far too much.

Some of you may know this story about Joe Louis – the boxer and one of Detroit’s favorite sons.

He was set to fight a rematch against Billy Conn, a smaller, faster boxer who almost beat Louis once before. Conn planned to use the so-called “hit and run” strategy against Louis who was bigger and tougher.

So when reporters asked Louis how he would handle his opponent, the boxer coined a now famous line when he said “He can run, but he can’t hide.”

During the fight, Conn moved around quite a bit and gave Louis a tough fight. But in the 8th round, Louis caught up to him and knocked him out.

We know criminals will continue to try everything they have to out smart us and out run us.

But these days they’re beginning to learn that they can’t hide. They are more likely to get caught, and when they do, the penalties are going to hurt.

We’ve made enormous progress – law enforcement and health care providers, policy makers, seniors and students working together to protect our health care system for future generations.

But we have more work to do and your insight here today and your leadership in the months and years ahead is critical to our continued success.

Thank you.