From: drarwingnuttephd@gmail.com   
      
   New Tools to Fight Fraud, Strengthen Federal and Private Health Programs, and   
   Protect Consumer and Taxpayer Dollars   
      
   Recent Initiatives Help the Government Fight Fraud, Strengthen Health   
   Insurance Programs, and Protect Consumer and Taxpayer Dollars   
      
   The Obama Administration has made important strides in reducing fraud, waste,   
   and abuse across the government. Over the last two years, the Centers for   
   Medicare & Medicaid Services (CMS) has implemented powerful new anti-fraud   
   tools and designed and    
   implemented large-scale, innovative improvements to our Medicare program   
   integrity strategy to shift beyond a "pay and chase" approach to preventing   
   fraud before it happens. CMS is also collaborating more with the private   
   sector, law enforcement, and our    
   state partners to harness best practices in our fight against health care   
   fraud.   
      
   These efforts are paying off. In FY 2012, the government recovered a historic   
   $4.2 billion and has returned a record-breaking $14.9 billion dollars to   
   taxpayers between 2009 and 2012, up from $6.7 billion dollars over the prior   
   four years.   
      
   The Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint   
   effort between the Department of Health and Human Services (HHS) and   
   Department of Justice (DOJ) to fight health care fraud, has played a critical   
   role in these efforts. A key    
   component of HEAT is the Medicare Strike Force - interagency teams of   
   analysts, investigators, and prosecutors who can target emerging or migrating   
   fraud schemes, including fraud by criminals masquerading as healthcare   
   providers or suppliers.   
      
   In October 2012, Medicare Strike Force operations in seven cities led to   
   charges against 91 individuals - including doctors, nurses and other licensed   
   medical professionals - for their alleged participation in Medicare fraud   
   schemes involving    
   approximately $432 million in false billing. That total includes more than   
   $230 million in home health care fraud; more than $100 million in community   
   mental health care fraud and more than $49 million in ambulance transportation   
   fraud. In coordination    
   with the criminal charges, HHS also suspended or took other administrative   
   action against 30 health care providers following a data-driven analysis and   
   credible allegations of fraud. Under the Affordable Care Act, HHS is able to   
   suspend payments until an    
   investigation is complete. In May 2012, Medicare Strike Force teams charged   
   107 individuals, including doctors, nurses and other licensed medical   
   professionals, in seven cities for their alleged participation in Medicare   
   fraud schemes involving more than    
   $452 million in false billing.   
      
   In 2011, HEAT coordinated the largest-ever federal health care fraud takedown   
   involving $530 million in fraudulent billing. In one action, Strike Force   
   teams charged 115 defendants in nine cities, including doctors, nurses, health   
   care company owners and    
   executives, for their alleged participation in Medicare fraud schemes   
   involving more than $240 million in false billing. In another coordinated   
   takedown, Strike Force prosecution teams charged 91 defendants in eight cities   
   for their alleged participation    
   in a Medicare fraud scheme involving more than $290 million in false billings.   
      
   Other steps the Administration has taken to fight fraud include:   
      
   Tough New Rules and Sentences for Criminals: An unprecedented collaboration   
   between HHS and the DOJ on the joint HEAT Strike Force has charged more than   
   1,400 defendants who collectively have falsely billed the Medicare program   
   more than $4.8 billion    
   since 2007. In 2012, the Department of Justice opened 1,311 new criminal   
   health care fraud investigations involving 2,148 defendants. And thanks to the   
   Affordable Care Act, criminals convicted of fraud now face tougher sentences   
   and more jail time.    
   Criminals will receive 20 to 50 percent longer sentences for crimes that   
   involve more than $1 million in losses. The law also establishes penalties for   
   obstructing a fraud investigation or audit and makes it easier for the   
   government to recapture any    
   funds acquired through fraudulent practices.   
      
   Healthcare Fraud Prevention Partnership: The Obama Administration's fight   
   against healthcare fraud now includes the ground-breaking Healthcare Fraud   
   Prevention Partnership, a forum for the federal government and private and   
   state organizations, including    
   insurers, to prevent healthcare fraud on a national scale. To detect and   
   prevent payment of fraudulent billings, the Partnership seeks to exchange   
   information and best practices across the public and private sectors. The   
   Partnership will also perform    
   sophisticated analytics on industry-wide data that will detect and predict   
   fraud schemes that were previously undetectable in a fragmented healthcare   
   system.   
      
   Use of State-of-the-Art Fraud Detection Technology: In June 2011, CMS began   
   screening all fee-for-service Medicare claims through the new Fraud Prevention   
   System. Similar to the technology used by credit card companies, the Fraud   
   Prevention System    
   applies predictive analytic technology to claims prior to payment to identify   
   aberrant and suspicious billing patterns. Leveraging leads from this system,   
   CMS and its contractors perform reviews, in an effort to stop claims before   
   payment, and trigger    
   administrative actions and law enforcement referrals. Early results from the   
   Fraud Prevention System show significant promise. In its first year of   
   implementation, the Fraud Prevention System:   
      
   Generated leads for 538 new fraud investigations   
   Provided new information for 511 existing investigations   
   Triggered 617 provider interviews and 1,642 beneficiary interviews   
      
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