The Affordable Care Act Expands Federal Programs to Identify & Punish Fraud

June 08, 2010

The annual Health-Care Fraud and Abuse Control Program report released by HHS and the Office of the Attorney General expressed the intent of the federal agencies to actively pursue and prevent Medicare fraud.

“The Affordable Care Act gives us new tools to fight fraud, protect consumers and safeguard taxpayer dollars,” said HHS Secretary Kathleen Sebelius. “It strengthens our ability to stop fraud before it starts by making it harder to submit false claims and easier to catch those who try to cheat our consumers. And, the new law will guarantee that those who try to game the system face severe consequences.”

In addition to strengthening law enforcement capabilities, the new law will also shift the emphasis from the old model of “pay and chase” to a new model that focuses on fraud prevention.

“The Affordable Care Act targets resources to areas where fraud and abuse are greatest, coordinates and consolidates fraud-fighting efforts across Medicare and Medicaid, and expands the partnership with the private sector to help eliminate fraud.” 

In fiscal year (FY) 2009, anti-fraud efforts resulted in $2.51 billion being deposited to the Medicare trust fund, a $569 million, or 29 percent, increase over FY 2008. In addition, more than $441 million in federal Medicaid money was returned to the Treasury, a 28 percent increase from FY 2008.

“The Affordable Care Act will build on innovative strategies to fight fraud such as Project HEAT, the joint operation between the Department of Justice (DOJ), CMS and the HHS Office of Inspector General, that has unleashed special strike forces in six states to target health-care fraud hot spots like South Florida, New York, Texas, California, Louisiana and Michigan.” 

DOJ and HHS officials stressed that the expanded law enforcement efforts will be supported by the newly established center for program integrity at CMS, which will use state-of-the-art methods to implement provisions of the Affordable Care Act that detect fraud and prevent improper payments. The center will also work with the private health-care sector to better target fraud and abuse.

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