CHICAGO—(ENEWSPF)—April 4, 2012. Thank you, Dr. Budetti for those kind words – and for your outstanding leadership as Deputy Administrator for Program Integrity for the Centers for Medicare and Medicaid Services. It’s a pleasure to be back in Chicago today – and a privilege to join with you and Pat Fitzgerald, the outstanding United States Attorney for the Northern District of Illinois, as well as my good friend, Secretary Sebelius – in discussing the extraordinary progress we’ve made in preventing and combating health care fraud across this region – and in exploring strategies, and new technological tools, for taking our national efforts to a new level.
I’d particularly like to recognize each of the Administration leaders, law enforcement officials, investigators, prosecutors, industry representatives, and other critical partners who are with us today. In so many ways, the people in this room are at the heart of our efforts to protect the American people from health care fraud – not just in the Chicago area, but in communities throughout the country.
Although you’re approaching this problem from many different perspectives, you have seen the devastating impact of health care fraud firsthand. Many of you have called attention to the fact that modern schemes are as diverse as the imaginations of those who perpetrate them, and as sophisticated as technology will permit. And there’s no question that – here in Illinois and across the nation – the challenges before us have reached crisis proportions.
Fortunately – as a result of your engagement, your expertise, and your unwavering commitment – we’ve made remarkable, measurable strides in implementing the solutions that we need – and that American consumers, patients, and taxpayers deserve. We’re being innovative, proactive, and collaborative. And, as a result, the last three years have been characterized by significant – and, in many cases, record – progress, particularly in our ability to analyze claims and other data in order to rapidly identify emerging fraud patterns.
How did we get here? In large part, because – nearly three years ago – the Departments of Justice and Health and Human Services came together in a new way, and made a collective commitment to meeting our shared goals and responsibilities. This commitment inspired Secretary Sebelius and I to launch a landmark joint initiative – the Health Care Fraud Prevention and Enforcement Action Team, known as “HEAT.” Since then, Secretary Sebelius and I have traveled across the country – and held six other regional summits like this one – in order to ensure that this fight will remain a top priority for state and local officials, for federal investigators and prosecutors, and for our industry partners.
With each of these gatherings – as with today’s important Summit here in Chicago – we’re sending a powerful signal to all those who would threaten the strength and integrity of our health care system: that a new era of communication and cooperation has begun. And that this Administration has never been more determined to move aggressively in protecting patients and consumers, bringing criminals to justice, and building on what’s already been achieved.
Since its inception, HEAT has helped to leverage the tremendous strength of federal, state, and local partnerships – and enhanced our ability to protect taxpayer dollars and the integrity of government programs that depend on those dollars. It also has strengthened our ability to hold accountable those who have violated our laws in order to victimize the most vulnerable members of our society. A driving force behind this work has been our Medicare Strike Forces, which focus attention and resources on major fraud “hot spots” across the country.
To date, Strike Force operations have charged more than 1,200 defendants for fraudulently billing the Medicare program for more than $3.7 billion. Our agencies have expanded Medicare Strike Forces to nine locations – including, as of last February, Chicago.
This has enabled us to build substantial momentum. And the results we’ve achieved have been nothing less than historic.
In fact, during the last fiscal year alone, civil and criminal health care fraud enforcement efforts by the Justice Department and HHS recovered nearly $4.1 billion in funds stolen or taken improperly from federal health care programs across the country. This is an unprecedented accomplishment. It represents the highest amount ever recovered in a single year. And the landmark Affordable Care Act gave us additional critical resources, tools, and authorities to continue this important work. Over the same period, we also opened thousands of new criminal and civil health care fraud investigations, dismantled criminal enterprises, thwarted large-scale fraud schemes, and secured more than 700 convictions. Perhaps most notably, our investments in this work are yielding extraordinary returns: over the last three years, for every dollar we’ve spent fighting against health-care fraud, we’ve returned an average of seven dollars to the U.S. Treasury, the Medicare Trust Fund and others.
These numbers are stunning. But – as you’ve seen right here in Chicago – they are only the beginning.
Last September – as part of a nationwide Medicare Strike Force takedown – four Chicago residents – including one doctor – were charged for their roles in a variety of alleged schemes defrauding the Medicare program of more than $4 million. In all, a total of 91 defendants were charged for submitting more than $295 million in false billings – marking the highest amount of false Medicare billings for a single operation in the Strike Force’s history.
In February, a judgment of over $16 million was entered in a civil lawsuit filed by the United States against a healthcare clinic. The clinic was charged for illegally administering prescriptions and for allowing unlicensed and unqualified practitioners to treat patients for mental health issues. In a separate case, last month, 11 new defendants were added to a federal indictment against an individual who operated two home health care businesses in Chicago. The new defendants allegedly conspired to swindle Medicare of at least $20 million over a five year period. And a little over two weeks ago, the Department of Justice reached an $18.5 million settlement with a Chicago-area firm charged with improperly billing Medicare for ambulatory cardiac telemetry services.
Thanks largely to the remarkable efforts of U.S. Attorney Fitzgerald and his team, as well as the Justice Department’s Criminal and Civil Divisions, the HHS Office of the Inspector General, and other key federal, state, and local law enforcement partners – since HEAT expanded to Chicago in February 2011, we’ve charged a total of 37 defendants in 15 separate criminal cases related to health care fraud right here in the Northern District of Illinois. They’ve set an excellent example – and, in the fight against health care fraud, are providing a model for success.
These cases, and countless other local civil and criminal enforcement actions, are emblematic of our nationwide achievements. They prove that our collaborative efforts are working. And they reinforce the importance of engagement, the value of public-private partnerships, and the critical nature of conversations like the one we’re hosting today – focused on harnessing the power of science and technology to make our efforts both more efficient and more effective.
Of course, despite everything we’ve achieved in recent years, we cannot yet be satisfied. And we can’t afford to become complacent. We have a great deal of work before us – and many more challenges and obstacles to confront. But, with your continued dedication, leadership, and partnership, I believe that the successes you’ve already helped bring about here in Chicago and beyond are just the beginning. In the work of protecting the American people from health care fraud, I am proud to count you as colleagues – and as partners. I am honored to stand with you today. And I look forward to all that we can – and will – accomplish together in the days ahead.
At this time, it’s my privilege to introduce another key leader of these efforts – my good friend, the Secretary of Health and Human Services, Kathleen Sebelius.