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Senate Judiciary Holds Hearing on Health Care Fraud

by Astrid Fiano, DOTmed News Writer | November 11, 2009
Feds crack down
on Medicare fraud
The Senate Judiciary Committee held a recent hearing on the problems of health care fraud. According to Chairman Patrick Leahy (D-VT), the scale of health care fraud in America today is "staggering." "According to conservative estimates," the Senator said in his opening statement, "about three percent of the funds spent on health care are lost to fraud -- more than $60 billion dollars a year. In the Medicare program alone, the Government Accountability Office estimates that more than $10 billion dollars was lost to fraud just last year."

Senator Leahy expressed his appreciation that pending health care reform legislation includes provisions allowing for more access by law enforcement to essential information and appropriate access to the data and information needed to uncover fraud. "To stop the drain on our health care system caused by these types of fraud, we must make anti-fraud enforcement stronger and more effective. Much has been done to improve enforcement since the late 1990s, but we can and must go further."

Hearing witness Bill Corr, Deputy Secretary of the Department of Health and Human Services (HHS) testified that under President Obama's new priority in combating health care fraud, the government has had a more rapid response to fraudulent schemes and has increased recovery of funds lost to fraud than in previous years. Corr pointed out that the HHS Office of Inspector General investigations have resulted in $4 billion in receivables for FY 2009, and that strike force cases are indicted and litigated faster than traditional criminal health care fraud cases. Corr also recounted the $2.3 billion settlement with Pfizer to resolve criminal and civil liability form the illegal promotion of some pharmaceutical products, the largest health care fraud settlement in history.

In the federal health care fraud investigations, Corr explained that HHS most important components are the Office of Inspector General (OIG), CMS and the Food and Drug Administration (FDA). OIG's role is providing essential support through its analysis of data for patterns of fraud, conducting independent investigations, supporting federal prosecutions of providers who commit criminal and civil fraud and pursuing administrative remedies. CMS' field offices provide on-ground presence and conduct further data analysis to identify fraud trends, as well as significant data and analytical support to OIG and DOJ investigators and referrals of potential fraud cases for investigation to law enforcement entities. The FDA supports investigations of Food, Drug and Cosmetic Act violations and False Claims Act cases involving the illegal use of medicines for unapproved promotion.