In an effort to prevent the continued loss of billions of dollars in Medicare and Medicaid fraud, the Department of Justice and Department of Health and Human Services are teaming up on a new prevention and enforcement initiative.

U.S. Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced May 20, a new interagency effort dubbed the “Health Care Fraud Prevention and Enforcement Action Team (HEAT).

The HEAT team will include senior officials from both departments to build upon and strengthen existing programs to combat fraud while also investing new resources and technology to prevent fraud, waste and abuse before it happens, the agencies said in a joint statement.

DOJ-HHS Medicare Fraud Strike Force teams have been fighting fraud in South Florida and Los Angeles, using “data-driven” approaches to identify unexplainable billing patterns and investigating providers for possible fraudulent activity. The South Florida team, created in 2007, has logged convictions on 146 defendants and secured $186 million in criminal fines and the Los Angeles team, established in May 2008, has 37 defendants charged with fraud offenses and more than $55 million ordered in restitution to the Medicare program.

As part of the new HEAT initiative, teams will be expanded to operations in Detroit and Houston.

Eric Holder

Holder said with the announcement of HEAT, “we raise the stakes on health care fraud by launching a new effort with increased tools, resources and a sustained focus by senior-level leadership.”

“Every year we lose tens of billions of dollars in Medicare and Medicaid funds to fraud,” he said in a statement. “Those billions represent health care dollars that could be spent on medicine, elder care or emergency room visits, but instead are wasted on greed. This is unacceptable, and the Justice Department is committed to working with the Department of Health and Human Services to eradicate it.”

Sebelius added that currently, most providers are “doing the right thing and providing care with integrity.”

“But we cannot and will not allow billions of dollars to be stolen from Medicare and Medicaid through fraud, waste and serious abuse of the system,” she said. “It’s time to bring the fight against fraud into the 21st century and put the resources on the streets and out into the community to protect the American taxpayers and lower the cost of health care.”

The HEAT team will build on demonstration projects by the HHS inspector general and the Centers for Medicare & Medicaid Services that focus on suppliers of durable medical equipment, the agencies said. These projects increase site visits to potential suppliers to prevent impostors from posing as legitimate DME providers.

Other efforts by the team include increasing training for providers on Mediciare compliance, improving data sharing between law enforcement and the Centers for Medicare & Medicaid Services and strengthening programs to monitor and ensure Medicare Parts C (Medicare Advantage) and D (prescription drug programs) compliance and enforcement.

President Barack Obama’s proposed fiscal 2010 budget also invests $311 million to strengthen program integrity activities within the Medicare and Medicaid programs. Anti-fraud efforts in the budget could save the U.S. $2.7 billion over five years, according to the agencies.