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Statement of Assistant Attorney General for the Civil DivisionTony West Before the Senate Appropriations Subcommittee
Washington, D.C. ~ Tuesday, February 15, 2011

Thank you, Mr. Chairman, Senator Shelby, and Members of the Committee. It is a privilege to be here today to discuss the Department of Justice’s work, and particularly that of the Civil Division, to combat health care fraud and secure the recovery of taxpayer dollars on behalf of the American people. I am also pleased to be here today with our valued partner in these enforcement efforts, Deputy Administrator Peter Budetti from the Centers for Medicare & Medicaid Services.

As this Committee knows, the Civil Division represents the United States in courts throughout the Nation in a wide variety of matters. As the Justice Department’s largest litigating component, we defend Congress and the Executive Branch against challenges in court, and the cases we handle touch upon nearly every aspect of Federal Government operations and this Administration’s domestic, national security and foreign policy priorities.

Central to our mission is the recovery of taxpayer dollars that are lost to fraud, waste and abuse. And nowhere is this more evident than in the Civil Division’s efforts to fight fraud perpetrated against our public health care programs.

When I appeared before the Senate Judiciary Committee less than a month ago, I reiterated something I’ve said many times since assuming this role as head of the Civil Division: We in the Justice Department have recognized the urgency posed by health care fraud; that it not only costs taxpayers money, but also undermines the quality, integrity and safety of patient care.

And our efforts to curb health care fraud have paid off. The Department of Justice has never been more aggressive—or more successful—in the anti-fraud battle as it has in the last two years.

Indeed, since January 2009, the Civil Division has, working with the Nation’s U.S. Attorneys, opened more health care fraud matters, secured larger fines and judgments, negotiated higher settlements, and recovered more than $8.5 billion for the taxpayers in health care fraud cases— this is a record, representing more health care fraud monies recovered than in any other two-year period in the history of the Department of Justice.

And the cases that comprise that record-breaking amount span the broad spectrum of health care fraud, from sophisticated illegal overbilling schemes to individual doctors who endanger the lives of those in their care just to bump up their Medicaid reimbursements.

Now most health care providers, most companies and most individuals who do business with the Government when it comes to providing health care services, pharmaceuticals and medical devices—we know they are dealing fairly, playing by the rules and are careful with the taxpayer dollars they receive. They are trying to do the right thing.

But we have also found that sometimes, there are those who attempt to cut corners, take advantage, and put profits over patient safety, and those companies and individuals will continue to attract our enforcement attention.

Now, the historic recoveries we’ve been able to achieve in the fight against health care fraud have not happened by accident. It’s what happens when we maximize the efficient use of resources and combine that with the data sharing, enhanced collaboration and cooperative strategizing that has occurred since the creation of HEAT, the Health Care Fraud Prevention and Enforcement Action Team: a renewed commitment by Attorney General Eric Holder and HHS Secretary Kathleen Sebelius that seeks to bring to bear the enforcement and prevention tools of both Departments in fighting health care fraud.

That commitment has resulted in a record amount of civil, criminal and administrative recoveries of over $4 billion in FY2010—that’s $4 billion returned to the Medicare Trust Fund, victim agencies and others in the last fiscal year.

That success also demonstrates the impact we can have when we invest in our anti-fraud law enforcement efforts, as the President proposes to do in his budget announced yesterday. We’ve already seen what additional resources devoted to fighting health care fraud can produce. In fact, the three-year rolling average return on investments is 6.8—that’s nearly $7 recovered for every dollar spent on our health care enforcement efforts.

And given that these are complex, difficult cases that are resource-intensive; often take years to investigate and pursue, requiring the interviews of countless witnesses, the review of millions of documents, and the hiring of consultants and experts; the money we spend on health care fraud enforcement, Mr. Chairman, is one of the best investments we make as taxpayers.

My written testimony outlines in more detail some of the things we’re doing to fight health care fraud and I look forward to working with you, Mr. Chairman, and the members of this Committee as we work together to tackle the challenges posed by fraud on the American taxpayers. I thank you for the opportunity to be here, and I am happy to answer any questions you have.

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