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Government going after health care fraud hard

Compiled by Lois M. Collins

Deseret News

Published: Wednesday, Aug. 31 2011 8:32 a.m. MDT

Prosecution for health care fraud nationally this year has already outpaced all of 2010. And an analysis shows that revved-up efforts by the Justice Department should reach an 85 percent increase over last year's cases.

That's the word from the Transactional Records Access Clearinghouse, housed in Syracuse University, which has reported 903 prosecutions so far this fiscal year. The numbers were bolstered, it says, by a series of Federal Bureau of Investigations cases. In Puerto Rico, for instance, 420 defendants were charged this year. And in the 50 states, cases in the Southern District of Florida accounted for one-ninth of all prosecutions for health care fraud.

The full report says the current pace would mean 1,355 prosecutions this year, an increase of 85.4 percent over last year, when 731 cases were prosecuted.

The numbers were tracked using data obtained from the Executive Office for United States Attorneys, obtained through the Freedom of Information Act, the TRAC report said. It says the current caseload is a 157 percent increase from five years ago.

"Justice - FBI" accounted for 75.7 percent of prosecutions. The rest were primarily from investigations by the U.S. Department of Health and Human Services.

As for the charges, most were listed as health care fraud, followed by "mail fraud attempt and conspiracy". No. 3 was "mail fraud - fraud and swindles." Other categories each had fewer than 100 cases prosecuted.

Of the top 10, bank fraud was "the one showing the greatest projected increase in prosecution — up 2,000 percent — compared to one year ago." That statute also had the largest projected increase compared to five years ago, TRAC said.

Kelly Kennedy wrote for USA Today that the government recovered a record $4 billion in health care fraud cases.

That article noted one February case led to indictments of 111 people, "the largest take-down to date for the Medicare Fraud Task Force.... In that case, doctors, nurses and executives were accused of falsely billing Medicare more than $225 million."

There were 23 trial convictions last year for Medicare fraud and 24 convictions have been obtained this year.

"That's just a stunning number when you see it in the first eight months," Justice criminal division Assistant Attorney General Lanny Breuer told USA Today. "We're just going to build on this model and we're going to hold those responsible who are stealing from the government."

Health fraud prevention has been an ongoing effort. In late July, for instance, the federal government launched a pilot project in New Jersey that relies on public reporting of suspected health care fraud.

Data from the Centers for Medicare and Medicaid Services is sometimes used to find fraud, experts said. The site also has detailed instructions on how to report suspected billing fraud for the two federal programs.

USA Today said the fraud in Puerto Rico netted more than $7 million from bogus claims to American Family Life Insurance Company. It said some people submitted hundreds of accident claims, while paying a doctor $10 to $20 to fraudulently handle them.

EMAIL: lois@desnews.com, Twitter: Loisco

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