Health Care Fraud Prosecutions Up 78% Since Launch Of Affordable Care Act

It’s been more than two years since the Affordable Care Act was signed into law, and while the Supreme Court mulls over the reform’s future, a look back over the last couple years shows a sharp increase in health care-related criminal fraud charges.

According to numbers compiled from the Justice Dept. and the Dept. of Health & Human Services, the number of people charged with health care fraud has jumped up 78% from 803 in fiscal year 2009 to 1,430 in fiscal year 2011.

A good chunk of this success has to do with the Health Care Fraud Prevention and Enforcement Action Team (which goes by the name “HEAT” because “HCFPEAT” does not conjure up images of Al Pacino and Robert DeNiro involved in a shoot-out). HEAT pre-dates the signing of the Affordable Care Act, but in just the last few months it brought charges against 150 people alleged to be responsible for around $1 billion in fraud.

HEAT’s Medicare Fraud Strike Force recently charged more than 100 individuals in seven cities for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing.

In addition to increasing prosecutions on fraud charges, the Affordable Care Act also increased federal sentencing guidelines for health care fraud offenses by up to 50% for crimes involving more than $1 million in losses.

Another program that pre-dates the Affordable Care Act, the Health Care Fraud and Abuse Control Program (HCFACP, because not everything can have cool initials), has seen a 27% increase in convictions during the last two years. Additionally, since 2009, HCFACP has reportedly returned $10.7 billion to the Medicare Trust Funds.

“We are committed to using these new tools to fight Medicare and other health care fraud, and we are getting results,” writes White House Deputy Chief of Staff Nancy-Anne DeParle.

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  1. TuxthePenguin says:

    “A good chunk of this success has to do with the Health Care Fraud Prevention and Enforcement Action Team (which goes by the name “HEAT” because “HCFPEAT” does not conjure up images of Al Pacino and Robert DeNiro involved in a shoot-out). HEAT pre-dates the signing of the Affordable Care Act, but in just the last few months it brought charges against 150 people alleged to be responsible for around $1 billion in fraud. “

    and

    “Another program that pre-dates the Affordable Care Act, the Health Care Fraud and Abuse Control Program (HCFACP, because not everything can have cool initials), has seen a 27% increase in convictions during the last two years. Additionally, since 2009, HCFACP has reportedly returned $10.7 billion to the Medicare Trust Funds.”

    So, contrary to the headline, this isn’t really due to the ACA, but rather the government actually looking for fraud?

    • nicless says:

      Exactly. The title has nothing to do with the article. I’m going to start writing stories like this. “Man stops eating turkey, hasn’t punched a mime since!” Bob Smith stopped eating turkey 2 years ago. Since then he has not punched one mime! Also, Bob is in jail for punching a mime and now has no access to mimes.

    • PHRoG says:

      “In addition to increasing prosecutions on fraud charges, the Affordable Care Act also increased federal sentencing guidelines for health care fraud offenses by up to 50% for crimes involving more than $1 million in losses. “

      • Loias supports harsher punishments against corporations says:

        Still a very sketchy and questionable titling choice by Consumerist.

        • PHRoG says:

          Agreed…just pointing out that they at least TRIED to apply SOME relevancy. :P~

          • StarKillerX says:

            Actually I think it’s less a matter of being relevant and more about twisting a story to try and make it appear that passage of the Affordable Care Act is responsible for these prosecutions, which even the story says it isn’t.

            Ironically if a company tried doing something similar about something this site opposed the writers here would be some of the first condemning them for intentionally misleading information.

        • Happy Tinfoil Cat says:

          No *gasp* Say it is not so.

      • nicless says:

        Yes, that has nothing to do with “Health Care Fraud Prosecutions Up 78%” That is what happens AFTER the prosecution.

      • Bsamm09 says:

        So upping sentences leads to arrests?

  2. AllanG54 says:

    Finally the government is getting off their ass and doing something right.

  3. dush says:

    So both these fraud prevention programs predate and have nothing to do with the Affordable Care act. Why even mention the Affordable Care act then? Why not just extole the virtues of these fraud prevention teams?

    • StarKillerX says:

      Because the writer, and the site, support the Affordable Care Act and as such they are willing to mislead their readers if it means more people support the act.

      • ARP says:

        The ACA increased jail time for health care fraud- so it is somewhat related. Now, does the increased sentencing relate to the number of prosecutions? That’s a bit tenuous.

        • dush says:

          And all those criminals get even more free health care while they are in jail longer. The ACA at work providing health care.

      • magnetic says:

        I took it to be a, “See, if we let the government do health care, people will just commit fraud all the time” thing.

    • u1itn0w2day says:

      You are supposed to associate increased fraud investigations/prosecutions with saving money because there are less fraudsters out there billing the system. The spinsters want to associate their programs with any numerical positive they can.

      It should be noting increased prosecutions & convictions period.

  4. StarKillerX says:

    While I support cracking down on fraud, I have to ask, does HEAT work under the HCFACP or a different program?

    The reason I ask is that one of the things that annoys me, especially when we hear we can’t possibly cut spending, is the vast amount of duplication of services there are at all levels of government.

    • ARP says:

      I think they go by HEAT (shortened acronym) rather than HCFPEAT (proper acronym), I don’t think they’re duplicate.

      • dush says:

        Cool, they reduced the acronym by 3 letters. That will save money on printing costs.

  5. Fumanchu says:

    I hope that when the Assistance to insurance companies law get ruled unconstiutional by the supreme court that congress will bring back this provision. Fraud costs the nation double. It costs becuase the person shouldn’t be getting the money and it makes it harder to keep around such programs because of the costs wich hurts the people who actually need it.

  6. DrunkenMessiah says:

    “it brought charges against 150 people alleged to be responsible for around $1 billion in fraud. “

    Holy Shit! There are 150 individual people defrauding the system of more than $6.5 MILLION each!? That’s mind-blowing. Here we are with the DEA putting small time marijuana dealers/users in jail for decade-long sentences, but we allowed those monsters to take MILLIONS of dollars away from truly deserving candidates!? Insanity.

    Christ. At least it looks like we’re starting to bring things back into balance at least a little bit.

  7. IWanaGoFishing says:

    This doesn’t have much to do with the PPACA. It has more to do with the DOJ giving Assistant US Attorneys more incentive to timely intervene in qui tam actions brought under the False Claims Act, a statute which dates to the Civil War. AUSAs are also being pressed to make a decision to intervene in qui tam cases inside of 9 months, instead of the traditional year or more.

    The Executive Branch is trying to make the PPACA look like less of a failure.

    • ARP says:

      They’ve increased jail time, so yes, there probably is some incentive to prosecute under this law to get long jail times.

  8. frodolives35 says:

    If you are a health care provider defrauding for cash jail and restitution coupled with loss of future participation in government billing. If you are a dope head, doctor shopping loss of all future government medical benefits. If you are sick and using someone else’s government health insurance letter of apology and a hearty come on in. I think the savings on the first two will more then pay for number three.

  9. Baka-no-Kami says:

    I did a little checking. The HEAT team was put together in 2009 before the ACA was signed. So prosecution went up because the government hired people whose only job is to prosecute health care fraud.

    Where the ACA comes into it seems to be that once it became law it gave HEAT more money so they could expand the operation. It also gave them “tools” to fight fraud. In government speak that means it gave them permission to snoop around in patient files looking for evidence and/or made questionable, but common and not strictly illegal, practices as illegal.

  10. prizgrizbiz says:

    It also says a sharp increase in ‘charges’ not ‘convictions’.

  11. Chris W. says:

    Could the title of this story be any more (purposefully) misleading?