The Department of Justice has recovered more than $5.6 billion from individuals or entities attempting to defraud the U.S. government in fiscal 2011, including more than $2.9 billion from health care fraud alone, officials announced today.
The recovered funds include both civil and criminal fraud and are attributed to President Obama’s Campaign to Cut Waste and driven in part by unprecedented cooperation between DOJ and the Department of Health and Human Services to detect and halt fraud earlier.
The efforts involve new technology and a prescription modeling system, HHS Secretary Kathleen Sebelius said during a conference call.
“It’s similar to what credit card companies and banks use to spot erratic billing,” she said. “The system allows for all claims to be seen within one system as oppose to six different systems. … It will mean more timely payments and the ability to crack down on fraud.”
According to the Office of Management and Budget, it involves the expanded use of Medicare Fraud Strike Forces that monitor Medicare data in real time and work together to prosecute fraud more quickly, taking months, not years, to bring a fraud case to resolution. The Administration has recovered $15 billion since 2009.
Secretary Sebelius also announced additional steps to crack down on Medicare fraud by targeting prescription drugs. Patients sometimes “doctor shop,” visiting numerous doctors to get multiple prescriptions for OxyContin, Percocet, and other painkillers and narcotics that can then be sold or abused.
The Government Accountability Office recently reported that “170,000 Medicare beneficiaries received prescriptions from five or more” doctors for these kinds of drugs. HHS has issued guidance urging insurance companies to prevent such fraud by withholding payment on suspicious claims and activity.
“These are simple ways to protect taxpayers’ money and save lives,” Sebelius said.