Miami Herald - Wednesday, May 20, 2009
Lesley Clark And Jay Weaver, jweaver@MiamiHerald.com

A new joint effort by the Departments of Justice and Health and Human Services will bolster Medicare fraud strike forces in those coastal cities, as well as establish new ones in Detroit and Houston where suspicious billing schemes have spread, senior officials said.

The initiative will share intelligence and "real-time" data to prevent the criminal activity from taking root -- a problem that has long plagued the taxpayer-funded program for the elderly, disabled and indigent.

Attorney General Eric Holder stressed that the fight against both Medicare and Medicaid fraud -- estimated to be at least $60 billion a year -- must be part of the administration's greater ambitions to reform healthcare, a monumental political challenge.

"By all accounts, every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud," said Holder, who outlined the initiative with HHS Secretary Kathleen Sebelius at a news conference.

"Those billions of dollars represent healthcare dollars that could be spent on medicine, elder care or emergency room visits, but instead are wasted on greed."

The task force, dubbed the Health Care Fraud Prevention and Enforcement Team, or HEAT, would be run from the highest levels of government.

"It isn't something we're leaving to the staff," Sebelius said. "For the first time ever, at the Cabinet level, the attorney general and I are personally committed to making sure this effort is a success."

The announcement comes as President Barack Obama and major healthcare industry leaders have vowed to slash $2 trillion in healthcare costs over the next 10 years. Top congressional members have said repeatedly that reducing costs -- including Medicare fraud -- is the only realistic way to find funds to help cover the 45 million uninsured Americans.

"Medicare fraud is out of control, especially in my home state of Florida," said Republican U.S. Sen. Mel Martinez. "Now Congress needs to act to provide the tools necessary to better identify fraud early."

Earlier this month, Martinez introduced legislation that would protect seniors and doctors from identity theft, as well as keep criminals from becoming Medicare providers.

The joint plan announced Wednesday includes a recommendation by the Obama administration to invest $311 million in fiscal year 2010 -- a 50 percent increase over this year -- to fight fraud, waste and abuse in the Medicare program.

Medicare, which was adopted by Congress in 1965, suffers from lax oversight of fraudulent claims submitted by healthcare providers who have come up with sophisticated ways to exploit the vulnerable system. During the past year, The Miami Herald has published a series of stories showing how Medicare and its government contractors seem bent on paying claims quickly without verifying them.

Miami-Dade County, considered the nation's capital of Medicare fraud, has been overwhelmed by scams involving medical equipment supplies, HIV infusion therapy and healthcare for homebound diabetic patients. The fraud in Miami-Dade reaches at least $2.5 billion a year, according to the FBI and U.S. attorney's office in Miami.

In March 2007, the Justice Department and HHS launched the first Medicare fraud strike force, in South Florida. Over two years, prosecutors filed 87 indictments charging 159 defendants with fraud offenses.

Among the defendants: medical equipment operators, HIV clinic owners and physicians. Many of the conspiracies entailed stolen Medicare identification numbers, falsified prescriptions and kickbacks paid to patients.

Miami U.S. Attorney R. Alexander Acosta told the U.S. Senate Special Committee on Aging earlier this month that he started focusing on fraud because he was "absolutely disgusted" by the level of scams in South Florida.

Sebelius said the agency will work toward simplified billing with improved technology designed to identify fraud.

AARP, the nonprofit advocacy group for senior citizens, praised the Obama administration's stepped-up fight against Medicare fraud. "We simply cannot afford to pay for care that is never delivered and equipment that is not needed," said AARP Executive Vice President Nancy LeaMond.
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