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Effective Strategies for Preventing Health Care Fraud

Tony West, Assistant Attorney General for the Department’s Civil Division testified Wednesday at a Senate Judiciary Committee hearing on the prevention and law enforcement efforts to confront health care fraud.  In his testimony, AAG West described the Department’s actions to combat various forms of heath care fraud, including Medicare and Medicaid fraud. AAG West emphasized the importance of combating health care fraud, due to the detrimental impact it has on the American people:
We have a duty to the taxpayers.   Every year, hundreds of billions of dollars are spent to provide health security for American seniors, children, and the disabled.   While most medical or pharmaceutical providers are doing the right thing, when Medicare or Medicaid fraud occurs, it costs the American taxpayer real dollars.   Every year, billions of dollars are lost to Medicare and Medicaid fraud.
 AAG West then went on to describe the Department’s efforts to combat health care fraud and its combined efforts with other agencies, including the Department of Health and Human Services. In May 2009, Secretary Sebelius and Attorney General Holder announced the establishment of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), an initiative that led to a landmark settlement earlier this year.
 Last month, Pfizer Inc. and its subsidiary Pharmacia & Upjohn Company Inc. agreed to pay $2.3 billion to resolve criminal and civil liability arising from the illegal promotion of certain pharmaceutical products.   This is the largest health care fraud settlement in the history of the Department of Justice, the largest criminal fine of any kind imposed in the U.S., and the largest ever civil fraud settlement against a pharmaceutical company.
AAG West also described other Civil Division efforts including the Office of Consumer Litigation’s (OCL) investigation and prosecution of drug and device manufacturers who illegally promote and distribute inadequate and fraudulent products, and the Elder Justice and Nursing Home Initiative, which is intended to protect our elderly citizens:
Too often, our most vulnerable citizens are the ones that are taken advantage of, so special attention is needed to prevent and prosecute these crimes. Each year Medicare and Medicaid spend over $120 billion on long-term care services, including nursing homes.   At the same time, research shows that 11 percent of our seniors report experiencing at least one form of abuse, neglect, or exploitation.  
 AAG West concluded his testimony by emphasizing the importance of the agencies and Congress working together to combat health care fraud. He said:
As we have seen time and time again, the only way we can be truly effective in protecting the integrity of our public health programs is by combining the full panoply of our federal resources, our expertise, and our information across agency and jurisdictional lines.  The Department of Justice looks forward to working with Congress as we continue to prevent, deter, and prosecute health care fraud.
 You can read the full testimony, here. Learn more about our on-going efforts to stop Medicare fraud at:
Updated April 7, 2017