Secretary Sebelius & Attorney General Holder Weigh in on Miami Fraud Takedown

By Kathleen Sebelius & Eric Holder

We are proud to say that last week Miami was part of the largest-ever coordinated law enforcement takedown of 59 defendants charged with committing fraud against Medicare and Medicaid.

Medicare Fraud Strike Force teams in Miami and six other cities, operated in partnership by the Department of Health and Human Services and the Department of Justice, charged 107 people for allegedly submitting fraudulent claims to Medicare worth about $450 million.

In Miami, a total of 59 defendants were charged for their participation in various fraud schemes involving a total of $137 million in false billings for home health care, mental health services, occupational and physical therapy, durable medical equipment, and HIV infusion. Court documents allege that therapists at one mental health center were instructed to alter notes and other medical documents to justify community mental health center services for beneficiaries who did not need the services.

Since 2009, the Obama administration has more than quadrupled the number of Medicare Strike Force teams operating in fraud hot spots around the country. And the president’s 2010 health care law, the Affordable Care Act, has put more boots on the ground and established tougher sentences for those who commit fraud. More than 500 law enforcement agents participated in the May 2 operation.

The health care law and other recent legislation have also enhanced our ability to put in place cutting-edge technology that makes it possible to identify and respond to fraud faster. In the past, government was often two or three steps behind the perpetrators, too often showing up after the criminals had already skipped town.

The Affordable Care Act and other recent legislation give us new data-analysis tools to look at trends across claims data, instead of monitoring each claim individually. Using a technology similar to what credit card companies use to identify and stop suspicious payments before they go out, we are using new authorities under the health care law to suspend payments when there are credible allegations of fraud until an investigation is complete.

The Centers for Medicare and Medicaid Services has stopped payment or taken other administrative actions on 52 provider organizations connected to the May 2 arrests until we have investigated them fully. Now, those looking to rip off Medicare aren’t getting a head-start.

The health care law also gives us the authority to put in place new safeguards to keep bad actors out of Medicare and Medicaid in the first place. For example, we’ve established a tougher screening process for the enrollment of providers in the areas where fraud is most likely to occur, such as for home health visits or durable medical equipment like wheel chairs.

In short, we have made it harder to submit a fraudulent Medicare claim. Criminals who do are more likely to get caught: The number of defendants in all criminal health care fraud cases increased by more than 75 percent during the Obama administration, from 797 in 2008 to 1,430 last year. If convicted, criminals face longer jail sentences due to new sentencing guidelines.

This fight against fraud is a key part of the effort to strengthen Medicare for the future. According to the Medicare actuaries, the Affordable Care Act — including some of its key anti-fraud provisions — has extended the life of the Medicare Trust Fund by eight years to 2024.

We are committed to continuing to strengthen Medicare and Medicaid and getting the criminals out of our health care system so that we can ensure that our seniors and other vulnerable citizens in Miami and across the nation will have access to the high-quality, affordable health care that they need and deserve.

Eric Holder is the U.S. attorney general. Kathleen Sebelius is secretary of Health and Human Services. This op-ed was published in The Miami Herald.

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