On Monday U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and U.S. Associate Attorney General Thomas J. Perrelli announced a new report showing that the government’s health care fraud prevention and enforcement efforts recovered more than $4 billion in 2010.
The success of this joint Department of Justice (DOJ) and HHS effort was attributed to the Health Care Fraud Prevention & Enforcement Action Team (HEAT), which was created in 2009 to prevent waste, fraud and abuse in the Medicare and Medicaid programs.
HHS also announced new rules authorized by the Affordable Care Act to help stop health care fraud. Specifically, the rules:
- Create a rigorous screening process Types of providers and suppliers that have been identified in the past as posing a higher risk of fraud, for example durable medical equipment suppliers, will be subject to a more thorough screening process.
- Require a new enrollment process for Medicaid and CHIP providers. States will have to screen providers who order and refer to Medicaid beneficiaries to determine if they have a history of defrauding government.
- Allow enrollment to be stopped temporarily. If a trend that may indicate health care fraud is identified in a category of providers or geographic area, the program can temporarily stop enrollment as long as that will not impact access to care for patients.
- Allow payments to be suspended. Under the new rules, if there has been a credible fraud allegation, payments can be suspended while an action or investigation is underway.