Health care fraud costs the United States tens of billions of dollars each year. Some estimates put the figure close to $100 billion a year. It is a rising threat, with national health care expenditures estimated to exceed $3 trillion in 2014. Health care fraud schemes continue to grow in complexity and seriousness. The dedicated efforts of law enforcement are a major component of the fight against health care fraud.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or the Program) under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS), designed to coordinate Federal, state and local law enforcement activities with respect to health care fraud and abuse. In its seventeenth year of operation, the Program’s continued success confirms the soundness of a collaborative approach to identify and prosecute the most egregious instances of health care fraud, to prevent future fraud and abuse, and to protect program beneficiaries.
On May 20, 2009, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced the Health Care Fraud Prevention & Enforcement Action Team (HEAT), an initiative that combined increased tools and resources, with sustained focus by senior level leadership designed to enhance collaboration between the Department of Justice (DOJ) and investigative agencies. With the creation of the new HEAT effort, DOJ pledged a cabinet-level commitment to prevent and prosecute health care fraud. HEAT is comprisedof top level law enforcement agents, prosecutors, attorneys, auditors, evaluators, and other staff from DOJ, HHS, and their operating divisions, and is dedicated to joint efforts across government to both prevent fraud and enforce current anti-fraud laws around the country.
The mission of HEAT is:
- To marshal significant resources across government to prevent waste, fraud and abuse in the Medicare and Medicaid programs and crack down on the fraud perpetrators who are abusing the system and costing us all billions of dollars.
- To reduce skyrocketing health care costs and improve the quality of care by ridding the system of perpetrators who are preying on Medicare and Medicaid beneficiaries.
- To highlight best practices by providers and public sector employees who are dedicated to ending waste, fraud, and abuse in Medicare.
- To build upon existing partnerships between DOJ and HHS, such as our Medicare Fraud Strike Force Teams, to reduce fraud and recover taxpayer dollars.
The Criminal Division plays a critical role in HEAT. The Criminal Division’s Fraud Section has 40 prosecutors assigned on health care fraud matters across the country. Most of these 40 prosecutors are assigned to the Medicare Fraud Strike Force (MFSF). Partnering with nine U.S. Attorney’s Offices, the MFSF has filed almost 1000 cases, charging over 2100 defendants who collectively billed the Medicare program more than $6.5 billion. Almost 1500 of these defendants pleaded guilty and 200 others were convicted in jury trials; over 1200 defendants were sentenced to imprisonment for an average term of approximately 48 months.
In addition, the Criminal Division also investigates and prosecutes corporate matters involving larger medical providers and companies. As a result, the Criminal Division is involved in numerous corporate investigations initiated by False Claims Act lawsuits filed by qui tam relators or referrals from law enforcement agencies. In a recent speech, the Assistant Attorney General made clear that addressing large-scale corporate health care fraud is a key Criminal Division priority.
For particular questions relating to specific conduct, you should seek the advice of counsel, or contact the Department of Justice with the information listed below.
Correspondence relating to incidents of health care fraud may be sent to:
U.S. Department of Justice
1400 New York Avenue NW
Washington, DC 20005
Facsimile - 202-514-7021