Health Care Fraud Prevention and Enforcement Action Team (HEAT) Created to Combat Medicare Fraud

In response to what Attorney General Eric H. Holder describes as the loss of “tens of billions of dollars in Medicare and Medicaid funds to fraud,” the United States Department of Justice (DOJ) and the U.S. Department of Health & Human Services (HHS) have teamed up to create HEAT. Made up of senior officials from the DOJ and HHS, HEAT will take a two-prong approach to combating Medicare fraud: “build[ing] upon and strengthen[ing] existing programs to combat fraud” and “investing new resources and technology to prevent fraud, waste and abuse before it happens.”

Expansion of the Medicare Fraud Strike Force teams, currently active in South Florida and Los Angeles, is just one of several reported actions HEAT plans to use to combat Medicare fraud. From 2007 to the present, the Medicare Fraud Strike Force teams have “convicted 146 defendants and secured $186 million in criminal fines and civil recoveries” in South Florida, and have charged 37 defendants “with criminal health care fraud offenses” in Los Angeles, with more than “$55 million ordered in restitution to the Medicare Program.” According to Mr. Holder and HHS Secretary Kathleen Sebelius, HEAT’s other initiatives will include:

• Building on HHS and the Centers for Medicare & Medicaid Services (CMS) demonstration projects focused on suppliers of durable medical equipment (DME)
• Offering providers increased training and resources to assist in the identification and prevention of fraud
• Improving data sharing between CMS and law enforcement
• Strengthening program integrity activities related to Medicare Parts C (Medicare Advantage plans) and D (prescription drug coverage) compliance and enforcement

The DOJ and HHS also are encouraging the American public to get involved in their efforts to combat Medicare fraud by providing a new telephone number 1-800-HHS-TIPS (1-800-447-8477) for reporting suspected Medicare fraud.

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