Department of Justice, HHS Boosts Number of Investigators, Prosecutors Looking at Medicare, Medicaid Fraud

HHS and the Department of Justice on Wednesday launched the Health Care Fraud Prevention and Enforcement Action Team to detect and prevent fraud in Medicare and Medicaid, the Washington Post reports (Johnson, Washington Post, 5/21). DOJ also plans to establish teams to address fraud in the Medicare Part D program and CHIP (Kennedy, AP/Houston Chronicle, 5/20). Wednesday's announcement also included a recommendation by President Obama's administration to include $311 million in the fiscal year 2010 budget to address health care fraud, which is a 50% increase from FY 2009. According to Attorney General Eric Holder, efforts to combat health care fraud will contribute to the administration's health care overhaul plans (Clark/Weaver, McClatchy/Kansas City Star, 5/20).

The task force, which will include HHS and DOJ staff members, law enforcement agents and prosecutors, will meet biweekly, CQ HealthBeat reports (Norman, CQ HealthBeat, 5/20). Under the plan, existing enforcement teams in Miami and Los Angeles will be expanded and new teams will be established in Houston and Detroit, where officials say suspicious billing patterns have emerged. In addition, the plan will set up task forces in 10 other major cities, which were not named (AP/Houston Chronicle, 5/20). The enforcement teams will increase site visits to durable medical equipment suppliers upon their enrollment. In addition, officials will expand training to help providers identify and prevent fraud or other mistakes (CQ HealthBeat, 5/20). The task force will use electronic claims data to detect "unusual billing problems," according to the Post (Washington Post, 5/21). HHS Secretary Kathleen Sebelius said the task force also intends to simplify billing systems and assist state officials in conducting Medicaid audits (CQ HealthBeat, 5/20). According to Holder, the joint task force will allow officials to share real-time intelligence data on health care fraud by monitoring claims payments, billing patterns and targeted surveillance (AP/Houston Chronicle, 5/20).