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Government recovers $4 billion in stolen health care funds Posted: January 28th, 2011

By Maryalene LaPonsie

In fiscal year 2010, a joint effort between the Department of Justice and the Department of Health and Human Services (HHS) to uncover waste, fraud and abuse in the Medicare and Medicaid systems recovered a record $4 billion in fraudulent health care payments, according to an HHS news release.

The joint effort, called the Health Care Fraud Prevention & Enforcement Action Team (HEAT), expanded existing Medicare Fraud Strike Force teams and conducted outreach programs throughout the country to identify and target Medicare scams. There were 1,116 criminal health care fraud investigations with charges filed in 488 cases.

In conjunction with releasing the HEAT results for FY 2010, HHS announced new rules for the upcoming year that are intended to further eliminate health care fraud. Four key rules:

  1. Providers wishing to enroll in the Medicare, Medicaid and CHIP programs will be required to submit to a more rigorous screening process.
  2. Providers that have been dropped from Medicare or a state health care program for fraud will be barred from participating in any Medicaid or CHIP program.
  3. Enrollment for new providers and suppliers will be temporarily halted if a pattern of fraud is identified in a particular category of providers or geographic region.
  4. Payment to providers and suppliers suspected of fraud will be temporarily stopped until an investigation can be completed.