Health and Human Services Secretary Kathleen Sebelius speaks about the Medicare Fraud Strike Force.

Federal health care fraud prosecutions in the first eight months of 2011 are on pace to rise 85% over last year due in large part to ramped-up enforcement efforts under the Obama administration, according to new government statistics.


The statistics, released by the non-partisan Transactional Records Access Clearinghouse, show 903 prosecutions so far this year. That’s a 24% increase over the total for all of fiscal year 2010, when 731 people were prosecuted for health fraud through federal agencies across the country. Prosecutions have gone up 71% from five years ago, according to TRAC.

“This was a fairly dramatic number of prosecutions,” said David Burnham, co-director of TRAC. TRAC is a research organization at Syracuse University that submits Freedom of Information Act requests for government data, and then reports the results.

Justice Department officials said the increase runs parallel with what they’re seeing when looking at health care fraud broadly, in part because of a couple of big busts this year, as well as several cases involving fraud in the private sector.

“The trend certainly looks accurate and on track with our data,” said Justice spokeswoman Alisa Finelli, though she said she could not confirm the exact numbers. She cited a February case that brought in 111 people — the largest take-down to date for the Medicare Fraud Task Force — as a factor. In that case, doctors, nurses and executives were accused of falsely billing Medicare more than $225 million.

Task force convictions have also risen, according to Justice’s criminal division Assistant Attorney General Lanny Breuer. In 2010, the task force saw 23 trial convictions for Medicare fraud. In the first eight months of this year, they’ve had 24.

“That’s just a stunning number when you see it in the first eight months,” Breuer said of the task force. “We’re just going to build on this model, and we’re going to hold those responsible who are stealing from the government.”

The government beefed up its staffing this year, adding two health care fraud teams in February.

In 2010, the government recovered a record $4 billion from health fraud cases after the federal health care law created one agency and expanded another. The actuary for Medicare predicted provisions of the law would ultimately net $4.9 billion in fraud and abuse savings over the next 10 years, which will be rolled back into Medicare.

Over the past couple of years, the task force has used data from the Centers for Medicare and Medicaid Services to find people stealing millions of dollars.

Jerry Wilson, chief of the FBI’s health care fraud criminal investigation unit, said he has seen an increase in cases, though not at the levels TRAC found.

“We started to change our focus,” he said. His team homed in on criminal enterprises — such as 73 Armenians who defrauded the government of $163 million last fall, as well as major providers who defraud the government — such as corporations or hospitals. Usually, those cases come after a whistle-blower comes forward. In 2010, the government paid $300 million to whistle-blowers.

In January, the FBI went after 533 people in Puerto Rico who worked with doctors to send bogus accidental injury claims to American Family Life Insurance Company — ultimately bilking the company of $7 million. Some individuals submitted hundreds of accident claims, while paying a doctor $10 to $20 per claim to fraudulently approve them.

“The San Juan case just shows our desire to work the private insurance and the public insurance sides,” Wilson said. The case also boosted the government’s prosecution numbers.

Via USA Today