DOJ Posts Record For Health Care Fraud Cases

The Justice Department is on track to post a record number of health care fraud prosecutions in 2011. Researchers say DOJ reported 1,235 new cases this year, the largest since they began tracking the crime 20 years ago. U.S. Attorney's Offices in Miami, Puerto Rico and Houston accounted for the biggest number of cases. And DOJ officials say recoveries in these cases are bringing lots of money back to the U.S. Treasury. But some onlookers say the federal government can do more to nip health care fraud in the bud by cutting off payments to fraudulent recipients before they happen.

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2011 has been a record year for prosecutors who bring health care fraud cases. This year, the Justice Department pursued more than a thousand new criminal prosecutions nationwide. Authorities say the volume of theft from Medicare and Medicaid is huge and growing, as more sophisticated criminals tap the rich insurance programs.

NPR's Carrie Johnson has our story.

CARRIE JOHNSON, BYLINE: Talk to officials at the Justice Department or at Health and Human Services and they'll tell you government health care programs are under attack. Government estimates say fraud siphons off about $90 billion a year from programs that otherwise help elderly, poor and disabled people pay for medical services.

LEWIS MORRIS: These are services not going to needed beneficiary, but going into the pockets of criminals.

JOHNSON: Lewis Morris is the top lawyer for the inspector general at HHS.

MORRIS: In the old days, we really relied on a pay and chase model. The money would go out. Six months, a year later we would discover there was a fraud problem and hope to chase the criminal. By that point the money is gone.

JOHNSON: Now, he says, federal agents and prosecutors try to monitor billing records in real time, using computer technology to detect unusual charges and turn off the money spigot before the money goes out.

MORRIS: But in the same way that credit card company knows that you don't live in California and you didn't just buy twelve flat screens, we know that if someone has never had an amputation of the leg they don't need a leg prosthesis.

JOHNSON: Health and Human Services agents have been working side by side with prosecutors on special health care teams in nine different U.S. cities, bringing scams to light and bringing the scammers to justice. This year, the Justice Department brought more than 1,200 criminal prosecutions, according to a new study by the Transactional Records Access Clearinghouse at Syracuse University. The Syracuse report says that's the highest number in over a decade.

LANNY BREUER: And we're going to keep doing that.

JOHNSON: Lanny Breuer leads the criminal division at the Justice Department.

BREUER: We think it's important for the integrity of the Medicare program to make people understand that if they commit fraud and they're going to abuse the program, when we find them we're going to hold them accountable.

JOHNSON: In the past few years, fraud busters in the government have got some new tools, including stiffer prison sentences and more funding, to police the health care beat. And judges are paying attention too, Breuer says.

BREUER: We've received record number of sentences and record lengths in sentences in the most egregious cases. I think we've had a couple of people sentenced to 50 years in jail and a couple of others to 30, 35 years in jail.

JOHNSON: The Department of Health and Human Services says it's also working to ban those people and companies with bad records from participating in the Medicare or Medicaid programs. The government has signed on for the long legal struggle when prominent health care executives challenge such actions in court.

And more and more these days, federal authorities have another partner: industry whistleblowers. Such insiders helped Justice recover almost $3 billion in health care fraud money this year.

Neil Getnick, a New York lawyer, whose clients have alerted the feds to big dollar frauds, says several of those cases paid lasting dividends.

NEIL GETNICK: That's what it's all about. You want to get these recoveries and you want to get these convictions, so you can reform the way industry does business going forward. And I think that's exactly what's happening.

JOHNSON: Getnick predicts there will be more prosecutions and more big settlements in the year ahead.

Carrie Johnson, NPR News, Washington.

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