Fraud Takedown


By:  Kathleen Sebelius
Date: Oct. 4, 2012
Location: Washington, DC

Thank you, Attorney General Holder. And thank you for your partnership on this critical issue.

Today's announcement represents another setback for criminals intent on lining their pockets from the Medicare trust fund. As you just heard from Attorney General Holder, our enforcement efforts have led to dramatic increases in anti-fraud prosecutions and record recoveries over the last three years. In partnership with law enforcement, we've taken down criminal enterprises that in some cases had been robbing government health care programs and taxpayers for years.

These efforts will continue. But just as importantly, we've also begun putting in place a set of comprehensive measures for preventing fraud from happening at all. With the help of new tools in the Affordable Care Act, we've made it significantly harder for crooks to submit fraudulent claims and get paid.

For example, we've established tougher screening procedures for providers and suppliers who want to participate in Medicare, including unannounced site visits in areas susceptible to fraud, like home health care and durable medical equipment. And we've begun a systematic review of all the providers and suppliers already in the system, which has led to nearly 20,000 providers and suppliers being deactivated.

We've also begun monitoring claims in real time, using innovative software that can detect suspicious billing patterns. If a supplier is billing for an unusually high number of electric wheelchairs, for example, we can now suspend payments while we conduct an investigation to be sure they're legitimate.

And when criminals do get caught, they'll face toug her penalties. Medicare and Medicaid fraud not only robs taxpayers. It also jeopardizes the future of programs that more than 100 million Americans depend on every day. The new penalties reflect the seriousness of this crime, dictating sentences of between 20 and 50 years for the biggest offenses.

Finally, we've put in place some common sense safeguards that prevent bad actors who had been kicked out of Medicare from continuing to bill state Medicaid programs as if nothing had happened.

Simply put: health care fraud has never been a worse proposition than it is today. It's harder to get into the system. You're more likely to get caught if you make a fraudulent claim. And when you do, you're going to pay a bigger price.

What motivates these efforts is this Administration's commitment to keeping Medicare and Medicaid strong for those Americans today and for future generations. To do that, we need to make every dollar count. And that means doing everything we can to stamp out waste and fraud.

Today's takedown is evidence that we're making progress. And it should send a clear message to those perpetrating or contemplating Medicare or Medicaid fraud that it's time to start looking for another line of work.

Thank you.

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