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Mixed Opinions About the Fight Against HealthcareFraud

February 1, 2010

Some media are citing optimism in the fight against health care fraud while others report that a recent emphasis on combating Medicare fraud has shown few results. For example, the number of indictments have increased only 2% since the establishment of the Medicare Strike Forces. In light of staggering healthcare fraud statisctics, many believe that Medicare fraud is not high enough on the Asministration’s list of priorities. According to Lois Saccoccio (head of the National Health Care Anti-Fraud Association), “fraud in the health care system is now “totally out of control.'”

Few would dispute that healthcare fraud is a problem of immense proportions, but DoJ is singing a more optomistic song about the effectiveness of law enforcement initiatives in combating the problem.  Speaking at the National Summit on Health Care Fraud, Attorney Heneral Eric Holder stated that the Health Care Prevention and Enforcement Action team (HEAT) has made great progress in reducing the numbers regarding health care fraud. According to the DoJ, last year alone 800 health care defendants were charged, 580 were convicted, and $2.2 billion was recovered under the False Claims Act. Attorney General Holder maintains that HEAT must be strengthened; we need to continue to support the Medicare Strike Force and continue to work with Congress to regulate and legislate health care fraud.

Unquestionably, law enforcement initiatives such as HEAT should be strengthend, but the best way to combat heatlhcare fraud is for those who know about it to report it. The vast majority of the $2.2 billion of recoveries reported by the DoJ were made as a result of some brave individual blowing the whistle. And that is only a drop in the bucket — most healthcare fraud goes unreported and therefore undetected.  The only way we will ever make a dent in the massive healthcare fraud that plaques our country is if those who turn a blind eye recognize that they are part of the problem.  False billing, false admissions of patients, unneccesary procedures, upcoding, illegal marketing — are all frauds that are witnessed yet unreported everyday.  If you are aware of Medicare or Medicaid fraud, don’t sit idly by — report it.  As a whistleblower, you are entitled to certain statutory protections and a percentage of the penalty against the wrongdoers.

To report Medicare Fraud, contact Frohsin and Barger.

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