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Attorney General Eric Holder and HHS Secretary Kathleen Sebelius today released the annual Health Care Fraud and Abuse Control (HCFAC) Program report showing that for every dollar spent on health care-related fraud and abuse investigations through this and other programs in the last three years, the government recovered $8.10. This is the highest three-year average return on investment in the 17-year history of the HCFAC Program.
The government’s health care fraud prevention and enforcement efforts recovered a record-breaking $4.3 billion in taxpayer dollars in Fiscal Year (FY) 2013, up from $4.2 billion in FY 2012, from individuals and companies who attempted to defraud federal health programs serving seniors or who sought payments from taxpayers to which they were not entitled. Over the last five years, the administration’s enforcement efforts have recovered $19.2 billion, up from $9.4 billion over the prior five-year period. Since the inception of the program in1997, the HCFAC Program has returned more than $25.9 billion to the Medicare Trust Funds and treasury.
These recoveries, released today in the annual HCFAC Program report, demonstrate President Obama’s commitment to making the elimination of fraud, waste and abuse, particularly in health care, a top priority for the administration. This is the fifth consecutive year that the program has increased recoveries over the past year, climbing from $2 billion in FY 2008 to over $4 billion every year since FY 2011.
The success of this joint Department of Justice and HHS effort was made possible in part by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), created in 2009 to prevent fraud, waste and abuse in Medicare and Medicaid and to crack down on individuals and entities that are abusing the system and costing American taxpayers billions of dollars.
“With these extraordinary recoveries, and the record-high rate of return on investment we’ve achieved on our comprehensive health care fraud enforcement efforts, we’re sending a strong message to those who would take advantage of their fellow citizens, target vulnerable populations, and commit fraud on federal health care programs,” said Attorney General Eric Holder. “Thanks to initiatives like HEAT, our work to combat fraud has never been more cooperative or more effective. And our unprecedented commitment to holding criminals accountable, and securing remarkable results for American taxpayers, is paying dividends.”
“These impressive recoveries for the American taxpayer are just one aspect of the comprehensive anti-fraud strategy we have implemented since the passage of the Affordable Care Act,” said HHS Secretary Sebelius. “We’ve cracked down on tens of thousands health care providers suspected of Medicare fraud. New enrollment screening techniques are proving effective in preventing high risk providers from getting into the system, and the new computer analytics system that detects and stops fraudulent billing before money ever goes out the door is accomplishing positive results – all of which are adding to savings for the Medicare Trust Fund.”
The new authorities under the Affordable Care Act granted to HHS and the Centers for Medicare & Medicaid Services (CMS) were instrumental in clamping down on fraudulent activity in health care. In FY 2013, CMS announced the first use of its temporary moratoria authority granted by the Affordable Care Act. The action stopped enrollment of new home health or ambulance enrollments in three fraud hot spots around the country, allowing CMS and its law enforcement partners to remove bad actors from the program while blocking provider entry or re-entry into these already over-supplied markets.
The Justice Department and HHS have improved their coordination through HEAT and are currently operating Medicare Fraud Strike Force teams in nine areas across the country. The strike force teams use advanced data analysis techniques to identify high-billing levels in health care fraud hot spots so that interagency teams can target emerging or migrating schemes as well as chronic fraud by criminals masquerading as health care providers or suppliers. The Justice Department’s enforcement of the civil False Claims Act and the Federal Food, Drug and Cosmetic Act has produced similar record-breaking results. These combined efforts coordinated under HEAT have expanded local partnerships and helped educate Medicare beneficiaries about how to protect themselves against fraud.
In Fiscal Year 2013, the strike force secured records in the number of cases filed (137), individuals charged (345), guilty pleas secured (234) and jury trial convictions (46). Beyond these remarkable results, the defendants who were charged and sentenced are facing significant time in prison – an average of 52 months in prison for those sentenced in FY 2013, and an average of 47 months in prison for those sentenced since 2007.
In FY 2013, the Justice Department opened 1,013 new criminal health care fraud investigations involving 1,910 potential defendants, and a total of 718 defendants were convicted of health care fraud-related crimes during the year. The department also opened 1,083 new civil health care fraud investigations.
The strike force coordinated a takedown in May 2013 that resulted in charges by eight strike force cities against 89 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings. As a part of the May 2013 takedown, HHS also suspended or took other administrative action against 18 providers using authority under the health care law to suspend payments until an investigation is complete.
In FY 2013, the strike force secured records in the number of cases filed (137), individuals charged (345), guilty pleas secured (234) and jury trial convictions (48). Beyond these remarkable results, the defendants who were charged and sentenced are facing significant time in prison – an average of 52 months in prison for those sentenced in FY 2013, and an average of 47 months in prison for those sentenced since 2007.
In March 2011, CMS began an ambitious project to revalidate all 1.5 million Medicare enrolled providers and suppliers under the Affordable Care Act screening requirements. As of September 2013, more than 535,000 providers were subject to the new screening requirements and over 225,000 lost the ability to bill Medicare due to the Affordable Care Act requirements and other proactive initiatives. Since the Affordable Care Act, CMS has also revoked 14,663 providers and suppliers’ ability to bill the Medicare program. These providers were removed from the program because they had felony convictions, were not operational at the address CMS had on file, or were not in compliance with CMS rules.
HHS and the Justice Department are leading historic efforts with the private sector to bring innovation to the fight against health care fraud. In addition to real-time data and information exchanges with the private sector, CMS’ Program Integrity Command Center worked with the HHS Office of the Inspector General and the FBI to conduct 93 missions to detect, investigate, and reduce improper payments in FY 2013.
From May 2013 through August 2013, CMS led an outreach and education campaign targeted to specific communities where Medicare fraud is more prevalent. This multimedia campaign included national television, radio, and print outreach and resulted in an increased awareness of how to detect and report Medicare fraud.
To read today’s report visit http://oig.hhs.gov/publications/docs/hcfac/FY2013-hcfac.pdf
For previous years’ reports visit https://oig.hhs.gov/reports-and-publications/hcfac/index.asp
For more information on the joint DOJ-HHS Strike Force activities, visit: www.StopMedicareFraud.gov/.
The official Republican response to President Obama’s State of the Union — delivered on national television to millions of people — by Rep. Cathy McMorris-Rogers centered around a FAKE Obamacare horror story.
That’s right, the story that Republican Rep. Cathy McMorris Rodgers told to the nation about “Bette in Spokane” facing a premium increase of “nearly $700” under the Affordable Care Act was a lie. This comes after a long string of false Obamacare horror stories from John Boehner and his Republican cronies.
We can’t continue letting these House Republicans get away with blatantly misleading the American people. Here’s the facts on McMorris-Rogers’s tall tale in her State of the Union response:
- The Spokesman Review reported that “Bette in Spokane” was not forced to pay $700 more a month.
- In fact, she had other, cheaper health care options available in Washington through the health exchanges — she simply chose not to avail herself of those options.
- Bette never spoke with McMorris Rodgers’s office to tell the whole story.
When Republicans in Congress mislead the American people, it’s up to us to call them out and demand they set the record straight.
The GOP’s belated solution to the nation’s health insurance challenges just makes working families pay more.
— by Emily Schwartz Greco
Remember when it looked like the Republican Party could do nothing but stamp its feet and shout about the Affordable Care Act’s shortcomings without coming up with any alternatives?
OK, there was former Sen. Jim DeMint’s suggestion last summer that having the uninsured continue to abuse emergency-room services due to a lack of options would work better than President Barack Obama’s health insurance reform. And conservatives enjoy boasting about how many ideas for overhauling the nation’s health insurance system the GOP has lobbed over the years into what it might call the marketplace of ideas.
The Unaffordable Health Care Act, an OtherWords cartoon by Khalil Bendib
Since none achieved any traction, the Republicans in Congress are trying again.
Maybe this escaped your attention. After all, Obama signed the Affordable Care Act into law in 2010 and it’s now being implemented regardless of those 47 House repeal votes. Perhaps you heard about its rocky roll-out? Warts and all, major government programs are as easy to revoke as it is to get toothpaste back into the tube.
Plus, four years is a long time, especially when news cycles are so short that blinking means missing out on key developments like Justin Bieber’s latest travails.
The GOP is moving ahead anyway with new plans to replace the Affordable Care Act that are sure to go nowhere in our gridlocked Congress. A trio of Senate Republicans is leading the way with a new approach that upholds the party’s unofficial allegiance to the “WeDon’tCare” creed.
That’s the term Jim Hightower has used to describe Rep. Paul Ryan’s dream of converting Medicare into a privatized voucher scheme.
WeDon’tCare also serves as the Republican approach to many other urgent problems dogging the United States. Intractable unemployment? Rising hunger? Pollution? Climate change? The GOP just doesn’t care.
Maybe you do care and wish Republicans would too. But this policy does have plenty to offer. It’s versatile, consistent, and great for time management.
The GOP’s WeDon’tCare policy is very attractive for lawmakers who might have better things to do with their time than get bogged down in petty problems. Rather than grapple with issues that are making the lives of millions of Americans who can’t afford to make campaign contributions miserable, lawmakers free up time for other activities. Like golf. And taking free trips to France.
The new Republican plan probably won’t save any more tax dollars than the Affordable Care Act and might actually save less. It won’t shock you to hear that it’s structurally very similar to the system often called Obamacare except that its subsidies would be financed more by working families and less by taxes on corporations and the very rich.
Under this new plan, outlined in legislation introduced by Republican Senators Orrin Hatch of Utah, Richard Burr of North Carolina, and Tom Coburn of Oklahoma, insurance companies wouldn’t have to cover preventive care any more. Once again, insurers could charge women more than men. Unlike with the Affordable Care Act, the vast majority of Americans insured through their workplace would start paying more for their coverage. And if that isn’t enough, there are also, plans in motion to set some seriously low caps on amounts for which patients who’ve been harmed can sue the one or ones who did the harming.
I bet there’s a good chance that it will matter to you, personally, should this ever manage to get enacted. You might even get angry.
What about House Republicans? Majority Leader Eric Cantor says they’re on it, with Representatives Dave Camp and Fred Upton — both with Michigan seats — and John Kline of Minnesota taking the lead. If you’d like some specifics, you’ll have to wait a bit longer since apparently they need more time.
Why are they even bothering?
“Pointing and laughing at the failures of Obamacare will not be a sufficient governing vision,” conservative Michael Gerson observed in one of his recent columns.
Something more, in other words, is required to win back the White House. Having a presumed front-runner for the Republican nomination who isn’t embroiled in a career-killing scandal would be helpful.
But if the GOP really wants to fare better in the 2016 presidential election than it did in 2008 and 2012, Republicans will need to ditch their WeDon’tCare platform on health insurance and other issues voters care about.
Emily Schwartz Greco is the managing editor of OtherWords, a non-profit national editorial service run by the Institute for Policy Studies. OtherWords.org
Nearly 2.2 million Americans selected plans in the Health Insurance Marketplace from October through December
Thirty percent of those who selected plans were under age 35
Nearly 2.2 million people have selected plans from the state and federal marketplaces by Dec. 28, 2013 (the end of third reporting period for open enrollment), Health and Human Services Secretary Kathleen Sebelius announced today.
A new HHS report provides the first demographic information about enrollees. December alone accounted for nearly 1.8 million enrollees in state and federal marketplaces. Enrollment in the federal Marketplace in December was seven-fold greater than the combined total for October and November – and eight-fold greater for young adults ages 18 to 34.
“Americans are finding quality affordable coverage in the Marketplace, and best of all, because coverage began on New Year’s Day, the promise and hope of the Affordable Care Act is now a reality,” Secretary Sebelius said. “Our outreach efforts have ramped up, so whether it’s through public service announcements, events, our champions or other means, we are doing all we can to find, inform and enroll those who can benefit from the Marketplace. There is still plenty of time for you and your family to sign up in a private plan of your choice, so visit HealthCare.gov to learn more and sign up now.”
Key findings from today’s report include:
- Nearly 2.2 million (2,153,421) people selected Marketplace plans from Oct. 1 through Dec. 28, 2013
- These signups in the state and federal marketplaces represent a nearly five-fold increase from October-November, including nearly 1.8 million (1,788,739) people who selected a plan in December (compared with the previous two-month cumulative total of 364,682 through Nov. 30, 2013).
- Of the almost 2.2. million:
- 54 percent are female and 46 percent are male;
- 30 percent are age 34 and under;
- 24 percent are between the ages of 18 and 34, and;
- 60 percent selected a Silver plan, while 20 percent selected a Bronze plan; and
- 79 percent selected a plan with Financial Assistance.
Today’s report also details state-by-state information where available. In some cases, only partial datasets were available for state marketplaces.
The report features cumulative data for the three-month period because some people apply, shop, and select a plan across monthly reporting periods. Enrollment is measured as those who selected a plan.
To read the report visit: http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Jan2014/ib_2014jan_enrollment.pdf
To hear stories of Americans enrolling in the Marketplace visit: http://www.hhs.gov/healthcare/facts/mystory/index.html
FACT: If you received a cancellation notice from your insurance company, that was their decision, not the federal government’s decision, even when it came to health insurance plans that didn’t meet PPACA minimum standards.
Corporations are a legal construction, they are NOT “people” and as such do NOT have the same rights as individual citizens. But, that doesn’t matter to corporate CEOs who are apparently practicers of far right religious zealotry. To them, it’s not sufficient to sequentially discriminate against individual citizens, they now want the right to discriminate against an entire class of citizens, women, based on the CEO’s religious zealotry. This has to stop!
If SCOTUS strikes the provision in ACA requiring employer policies to assure accessibility to contraception, is that the line they’ll draw? Or, what happens when the next religious zealot decides it’s against his religion to provide ANY healthcare whatsoever and that they should pray the sickness away instead. Will they rule in favor of that CEO’s views as well?
Republicans can use their revisionist history and scream as loud as they want, how this is a “christian” nation and how our founders intended to create a nation built upon those tenets, but that’s simply NOT the case. People migrated to the Americas to escape the religious discrimination and deadly purges present in Europe each time leadership shifted. At the time of our nation’s founding there were multiple religious groups who could have vied for the “official religion” yet that’s not what happened. Instead, our founding fathers created a “secular” nation with no official religion and no religious tests for its leadership. Instead they set into law, the tenet of religious freedom for all “men” (now interpreted for the last century to be a generic interpretation for both men and women).
Just as each individual President of the United States of America is denied the ability to put his religion above the law and impose his religious beliefs on the citizens of this nation, NO corporate CEO should be able to put his religion above the law and discriminate against U.S. citizens he’s hired to work in various roles within his U.S. incorporated business.
If the Supreme Court chooses to bestow religious rights on legal entities, corporations, it will set the stage for our next civil war — deciding which religious entity will be our nation’s official religion. So just like we’re seeing all that religious strife in the Middle East amongst the various religious Muslim sects, this could lead to religious strife across our nation.
Personally, I prefer a secular nation where people have constitutional rights and where corporations have rights to conduct business throughout out nation, but which are not afforded the exact same constitutional rights afforded the actual people of this nation.
NARAL Pro-Choice America on Supreme Court Decision to Hear Case on Contraception Coverage
Today, the Supreme Court granted certiorari in two cases related to the contraception benefit in the Affordable Care Act: Sebelius v. Hobby Lobby Stores, Inc and Conestoga Wood Specialties v. Sebelius. NARAL Pro-Choice America released the following statement from President Ilyse Hogue:
“While most people agree this much ado about birth control is a waste of time that could be spent on more pressing issues in our country, we’re pleased that the Supreme Court will finally lay to rest the question of whether women’s bosses get to decide if we deserve contraceptive coverage. That this reflects an underlying obsession with controlling women’s lives seems obvious when you observe that the enemies of the new law are not pushing to deny men access to Viagra or any other number of similar medical requests covered by insurance.
“Obviously, we hope the court upholds existing rulings that – in a country where over 99 percent of women report using birth control at some point in our lives – bosses have no business imposing their own politics on their employees’ health and decisions. If we start with birth control, will bosses next get to decide whether or not we get our children vaccinated? Or whether we can use treatments from stem cell research for life-threatening diseases? Allowing this intrusion into personal decisions by their employers opens a door that won’t easily be shut.”