Health Care Fraud Cases Drop Despite Bigger Budget

The official line at the Department of Justice is that investigators are battling Medicare and Medicaid fraud like never before. But the most recent data on the agency’s activities show that its efforts and ballooning budget have actually produced fewer results.

Despite a more than $200 million increase in funding in 2009, DOJ criminal convictions for health care fraud dropped slightly to 583 compared to 588 in 2008. These figures were included in a stinging letter from Iowa Senator Charles Grassley to Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen Sebelius. According to the letter, criminal prosecutions for health care fraud flat-lined during the same period, and the number of agency criminal health care fraud cases filed dropped by 21 to 481.

The Bush and Obama administrations both pushed money to the Department of Justice to ramp up their efforts at fighting health care crooks. Fraud and abuse has long hobbled the Medicare program, by some estimates siphoning off as much as 20 percent of the program’s budget.

In response, Holder and Sebelius in 2009 announced the Health Care Fraud Prevention and Enforcement Action Teams (HEAT) initiative, an expanded interagency taskforce that sifts through data to identify medical fraud hotspots. The HEAT initiative received good press, with high profile busts and strike teams operating in Southern Florida, Southern California, Detroit, Brooklyn, and other cities. But Grassley, citing DOJ data, found the results of the program wanting when considered as part of the agency’s overall efforts to dig out fraud.

Although the HEAT teams filed 82 criminal investigations in 2009, up from 30 a year before, that increase did not translate to more DOJ criminal cases filed overall.

“This raises a question of whether the focus of the HEAT initiative is actually redirecting resources away from overall criminal enforcement of health care laws,” Grassley wrote in the letter, which asked for more detailed data on the agencies’ efforts. “While this may be a statistical anomaly, it is clear that despite the HEAT initiative, criminal cases for health care fraud remain virtually unchanged since the initiative began.”