U.S. targets health care fraud
Officials say initiative has recovered $2.5 billion
LOS ANGELES – Dr. Anne Peters knew something was wrong when a fellow physician called to find out why she had been ordering so many MRIs for her patients.
The Los Angeles internist said she tried to alert authorities that someone was illegally using her physician identification and Medicare billing numbers to submit phony claims.
For months, Peters said, she couldn’t get anyone to listen. Because thieves had recruited or created phantom patients, the doctor had no way of resolving the problem. “Every agency told me the victim – i.e., the patient – had to report the fraud,” Peters recalled.
On Thursday, top Obama administration officials outlined new federal enforcement efforts to combat such health care fraud, saying quickly expanding criminal enterprises are costing taxpayers billions of dollars each year.
During a health care fraud summit in Los Angeles, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius said their agencies were jointly targeting fraud in the federal Medicare and Medicaid programs. They said the initiative, launched in May 2009, had so far produced more than 580 criminal convictions and recovered more than $2.5 billion.
“Our health care system is essentially under siege by criminals intent on lining their own pockets at the expense of the American taxpayers,” Holder told the gathering of law enforcement officials, regulators, health care executives and others at Los Angeles City College.
Sebelius said the federal Centers for Medicare and Medicaid Services issued a final regulation Thursday to protect seniors against fraudulent suppliers of medical equipment and supplies.
The new rule will require suppliers of prosthetics and other items to maintain proper ordering documentation and to remain open to the public at least 30 hours a week. It also will bar such companies from using cell phones or pagers as primary business phone numbers.
“The days when you could just hang a shingle out over a desk and start submitting claims are over,” Sebelius told the gathering. “No more power-driven wheelchairs for marathon runners.”
Sebelius apologized to Peters for the lackluster response to her reports and assured the doctor that the new health care reform law armed the government with new weapons to fight such fraud.
“There is a new sheriff in town,” Sebelius told Peters as the two stood outside the office building. “We are putting in place new protocols to be more aware and stop fraud in a much more timely fashion.”