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Team Obama Scores Big on Fraud & Abuse

Posted by John McDonough  February 16, 2012 11:00 PM

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I've written before about the Obama Administration's breakthrough efforts to fight health care fraud and abuse. Now there's more, $4.1 billion more.

Earlier this week, U.S. Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced that the federal government recovered $4.1 billion in taxpayer dollars from individuals and corporations attempting to steal Medicare and Medicaid payments to which they were not entitled.

What's $4.1 billion? It is the largest amount of money ever recovered, by far, in the history of the programs since they were established in 1965. Here are the numbers from the most recent years:

2005--$1.5B                                                                                                                                   2006 -- $2.2B                                                                                                                                 2007 -- $1.8B                                                                                                                                 2008 -- $1B
2009 -- $1.6B
2010 -- $2.5B

This progress is due to two factors: first, the expanded and smart provisions in Title VI of the Affordable Care Act giving new tools and powers to the federal and state governments to fight and prevent fraud and abuse; and second, the hyper-aggressive activities of the Obama Administration to catch and punish the bad guys.

Team Obama is not just catching bad guys, they are sending them away for a long time. Here is one of my favorite examples from the new annual report of the Health Care Fraud and Abuse Control Program (HCFAC):

In September 2011, the U.S. District Court in Miami sentenced the owner of a mental health care company (American Therapeutic Corporation, or ATC) to 50 years in prison for orchestrating a $205 million Medicare fraud scheme involving fictitious mental health services. The court also sentenced a co-owner to 35 years in prison and a third co- defendant to 91 months in prison following guilty pleas to their roles in the scheme. The defendants paid kickbacks to assisted living facilities and halfway houses in exchange for patients being brought to ATC facilities so they could bill Medicare for intensive mental health treatments that were medically unnecessary or never provided. ATC pleaded guilty to the charges in April and May of this year.

Two crooks, 85 years in the big house between them! I've heard that one of the best collection days in the history of the IRS was the day they sent Martha Stewart to jail because it told every other cheat in the nation that the same could happen to them.

The real value of this aggressive effort by the Obama Administration goes well beyond $4.1 billion. Every potential or real crook looking to Medicare and Medicaid as an easy place to steal money now has to think twice. The feds are coming after you, and they have no mercy. That's because the money you've been stealing comes from taxpayers and from Medicare enrollees who pay higher premiums because of your theft.  Sleep well!

During my time in DC working on the ACA, I observed that complaints about Medicare fraud and abuse were like complaints about the weather. Everybody complains, and nobody does anything about it. Can't say that about the Obama Administration.

$4.1 billion.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

John E. McDonough is a professor of practice at the Harvard School of Public Health. He is the author of the book “Inside National Health Reform”, published in 2011 by More »

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