Justice News

Attorney General Holder on New Medicare Fraud Initiative at a Press Conference with HHS Secretary Sebelius
Washington, DC
United States
~
Wednesday, May 20, 2009

Remarks as prepared for delivery.

Thank you for joining us today. I am pleased to stand with Secretary Sebelius to announce the formation of a senior-level taskforce, bringing together the leadership of our two agencies to tackle health care fraud throughout the country.

This is part of the administration’s ongoing commitment to fiscal responsibility and accountability, and putting the best minds and resources together to combat fraud and return much needed dollars into the U.S. treasury.

Most health care providers are honest people who want to help the public welfare and make a significant effort to follow the law. We look forward to working with them and want to encourage their voluntary efforts to root out waste and abuse and to institute effective compliance programs. But when individuals and corporations cross the line and defraud the public, we will hold them accountable. And unfortunately, there is far too much fraud and abuse going on in our health care system.

By all accounts, every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud. Those billions represent health care dollars that could be spent on medicine, elder care or emergency room visits, but instead are wasted on greed. This is unacceptable, and we at the Justice Department are committed to working with the Department of Health and Human Services to eradicate it.

Our agencies have been partners for several years in efforts to combat health care fraud. Since 1997, when Congress established the Health Care Fraud and Abuse Control program, our Departments have returned more than $14.3 billion to the federal government.

But we must do more, and today we raise the stakes on health care fraud by launching a new effort with increased tools, resources and a sustained focus by senior-level leadership. With the combined efforts of our two agencies, I believe we will make major strides in preventing, deterring and prosecuting health care fraud and abuse. We will also continue and enhance our efforts to educate stakeholders and to encourage the adoption of compliance programs and practices that so many providers have already adopted.

This taskforce – the Health Care Fraud Prevention & Enforcement Action Team (or HEAT) – is a working group of key stakeholders at the highest levels of DOJ and HHS that will increase coordination, intelligence sharing and training among our investigators, agents and prosecutors. As a top priority, this taskforce will look at how we can better share real-time intelligence data on health care fraud patterns and practices. The taskforce also will ensure that critical, up-to-date information about health care services, pharmaceuticals, and medical devices is readily exchanged between HHS and DOJ, increasing the efficiency and prompt resolution of complex health care fraud cases. It will also explore improvements in technology and training that will provide our analysts and agents with the best tools to effectively prevent fraud and abuse.

This DOJ-HHS coordination has already seen success in the Medicare Fraud Strike Forces we have deployed in key cities and regions throughout the country. In March 2007, our Departments joined forces to launch the 1st Strike Force in Southern Florida. Within two years, Miami Strike Force prosecutors filed 87 indictments charging 159 defendants with fraud offenses. In March 2008, the Strike Force expanded to Los Angeles, California. In one year, L.A. Strike Force prosecutors have filed 21 cases and three superseding indictments charging 37 defendants with health care fraud offenses.

The HEAT team will continue to combine and leverage the resources of both Departments, including the FBI and the Office of Inspector General at HHS, to prevent and prosecute fraud. The task force will also work closely with U.S. Attorneys Offices, which pursue both civil and criminal cases and dedicate substantial resources to combating health care fraud.

In addition to the indictments, convictions, and civil recoveries on behalf of federal health care programs, we must not underestimate the significant deterrent impact of our concentrated efforts. During the first year of Strike Force operations in Miami, we have estimated that billing for durable medical equipment fell by $1.75 billion in claims and $334 million in payments. Moreover, stepped up civil and criminal enforcement will continue to deter unlawful conduct and safeguard the public health put at risk by some unlawful practices.

We know these strike forces work, and today, we are announcing the expansion of Strike Force teams into Detroit and Houston. And in the coming months, we plan to send Strike Forces teams into several other areas of observed and concentrated Medicare fraud around the country. I believe a targeted civil and criminal enforcement strategy in these locations will have a substantial impact on deterring fraud and abuse, protecting patients and the elderly from scams, and ensuring that taxpayer funds are not stolen.

I spoke of data sharing, and I want to emphasize that this is a critical part of our partnership. Our HEAT taskforce will also work to expand our ability to analyze Centers for Medicare and Medicaid Services data in real time to identify and target those stealing from Medicare. This increased data sharing will not only allow us to stop fraudulent schemes and practices quickly before they take root, but it also will allow us to identify and expose systemic vulnerabilities that have been abused by health care providers. We have seen firsthand how such entities have robbed the Medicare Trust Fund through their accounting schemes, marketing practices, kickbacks, and profit maximization strategies, all at the expense of our Medicare and Medicaid beneficiaries.

And last but not least, we will work together with Congress to identify and pursue legislative and regulatory reforms that are needed to prevent, deter and prosecute health care fraud, such as removing barriers that impede the sharing of information and increased sanctions and penalties.

Earlier this month, ABC News aired a piece featuring a drug dealer who turned to Medicare fraud because it was faster and easier than selling drugs. It is time for us to get serious about this issue, and the Justice Department is committed to rooting out and punishing businesses and individuals who commit health care fraud. Our HEAT taskforce will combine the best of our best, fighting to combat fraud on behalf of the American people.

And now I want to introduce my partner in this initiative, Secretary of Health & Human Services Kathleen Sebelius.