BREAKING NEWS
Federal agents charged 94 people in Miami, Florida; Baton Rouge, Louisiana; Detroit, Michigan, and the Brooklyn borough of New York Friday with defrauding Medicare, the Department of Justice and other federal agencies said in a joint statement.
It is the largest health care fraud takedown since the creation of the Medicare Fraud Strike Force, known as H.E.A.T., three years ago. The defendants include doctors, health care company owners and executives, the statement said.
“Today’s arrests send a strong message that attempts to defraud Medicare will not be tolerated,” said Health and Human Services Secretary Kathleen Sebelius. “With the help of new tools in the Affordable Care Act, including stiffer penalties and better information sharing, we will continue to work with our federal, state and local partners to stamp out Medicare fraud and protect beneficiaries and the American taxpayer.”
The defendants are charged with conspiring to submit over $280 million in false claims to the federal health care program designed to aid the elderly.
Thirty-six defendants charged in the schemes have been arrested and additional arrests were expected throughout the weekend, federal officials said.
Charges include filing fraudulent claims for HIV/infusion services, home health care, physical therapy and durable medical equipment.
The Medicare Fraud Strike Force is a joint effort by the Department of Justice and the Department of Health and Human Services. The team works with federal, state and local investigators to analyze Medicare data and emphasizes community policing.
“With today’s arrests, we’re putting would-be criminals on notice: Health care fraud is no longer a safe bet,” Attorney General Eric Holder said. “The federal government is working aggressively – and collaboratively – to pursue health care criminals around the country and to bring these offenders to justice.”
Health care fraud fighters in Florida will now have additional funding to help find potential fraud and abuse in the state’s Medicaid program through use of Medicaid claims data.
Secretary Kathleen Sebelius announced this week that the U.S. Department of Health and Human Services (HHS) has approved Florida’s Medicaid waiver request to help fund a demonstration program that will allow the state’s Medicaid Fraud Control Unit (MFCU) to “mine” Medicaid Management Information System (MMIS) data to identify cases of potential Medicaid fraud.
Medicaid billing for many health care services in South Florida is disproportionately high compared to other parts of the country. Although significant progress has been made, fraudulent health care billing continues to cost Medicaid millions of dollars.
“To fight health care fraud, we need to coordinate all of the resources and data we can muster,” said Secretary Sebelius. “By allowing the state of Florida to use more information to find potential fraud in Medicaid, this waiver will improve Florida’s ability to effectively identify and combat fraud and abuse.”
The announcement comes in advance of the first joint HHS and Department of Justice (DOJ) Regional Health Care Fraud Prevention Summit, held at the Knight Center in Miami.
The summit, which featured keynote remarks by U.S. Attorney General Eric Holder and Secretary Sebelius, kicked off the first in a series of day-long summits bringing together a wide array of federal, state, and local partners, beneficiaries, providers and other interested parties to discuss innovative ways to eliminate fraud within the U.S. health care system.
As part of its efforts to coordinate the fight against fraud across the nation’s health care systems, including Medicaid and Medicare, data mining will allow Florida’s MFCU to sort electronic claims through the use of statistical models and intelligent technologies to uncover patterns and relationships. Using the identified patterns, investigators can review Medicaid claims activity and history to find abusive or abnormal use of services and potentially fraudulent billing. Data mining is done with software programs which include algorithms that automatically analyze MMIS data.
Currently, state MFCUs are prohibited from using federal Medicaid matching funds to detect potential fraud through routine claims review procedures such as screening of claims, analysis of billing practice patterns, or routinely verifying that billed services were actually received by patients, since these functions are a primary program operation function of the state Medicaid agency. Instead, MFCUs generally rely on referrals from the State Medicaid agency. The newly approved waiver will allow the Florida MFCU to use federal matching funds to apply sophisticated electronic data mining tools that are beyond the scope of the claims review activities normally performed by the State Medicaid agency to identify potential fraud.
CMS expects the MFCU to work closely with AHCA to ensure their collective efforts are effective. CMS will monitor progress of this waiver in conjunction with the HHS Office of Inspector General, which has oversight of MFCUs.
“The demonstration approved today will allow Florida’s Medicaid Fraud Control Unit to take full advantage of its expertise in detecting and investigating Medicaid fraud,” said CMS Administrator Don Berwick, M.D.
Prevention funds made available
In other federal news, HHS has announced awards of $10 million to 10 national non-profit organizations to support public health efforts to reduce tobacco use and reduce obesity through increased physical activity and improved nutrition.
These competitive awards are part of the HHS Communities Putting Prevention to Work (CPPW) initiative, a comprehensive prevention and wellness initiative funded under the American Recovery and Reinvestment Act of 2009.
“Communities Putting Prevention to Work” will help communities implement prevention policies including incentives to food retailers to locate and offer healthier options in underserved areas; healthier choices in child care, schools, and the workplace; subsidized memberships to recreational facilities; safe routes to school; and evidence-based strategies that discourage tobacco use and increase utilization of cessation programs.
“In the United States, seven of 10 deaths result from chronic disease, with tobacco, obesity, poor nutrition and lack of physical activity as the key risk factors for disease,” said HHS Assistant Secretary for Health Howard K. Koh, M.D., M.P.H.
The awardees are:
- American Academy of Pediatrics
- American Heart Association
- American Lung Association
- Association of American Indian Physicians
- BlazeSports America
- Community Food Security Coalition
- National Association of Latino Elected Officials
- National Recreation and Parks Association
- Sesame Workshop
- Society for Public Health Education
In addition to these new grant awards to national organizations, HHS will soon launch a National Prevention Media Campaign that will deliver hard-hitting advertisements to complement and support the work of CPPW. A contract for $28 million was recently awarded to the Academy for Educational Development (AED). This new media contract will also develop consumer materials for First Lady Michelle Obama’s Let’s Move! campaign aimed at preventing childhood obesity.
Links:
http://www.hhs.gov/ophs/funding/cppwfactsheet.htmlhttp://www.hhs.gov/recovery/programs/cppw/factsheet.htmlhttp://www.cdc.gov/chronicdisease/recovery
