2011: The Year for Health Care Fraud Prosecutions

Federal prosecutions for health care fraud are on the rise.  Statistics gathered for a recent study show that the U.S. Department of Justice has already commenced 903 health care fraud prosecutions in 2011.  Last year, federal prosecutors launched a total of 731 such cases.  If this pace continues, 2011 will see an 85% increase in health care fraud prosecutions.

New York’s prosecutors are playing a central role in these rising numbers.  Currently, the U.S. Attorneys in the Southern and Eastern Districts of New York rank, respectively, fourth and fifth in the nation in the number of health care fraud prosecutions filed.  Combined, the two offices have already sought 69 health care fraud prosecutions this year.  For comparison, ten years ago, in 2001, the U.S. Attorney for the Southern District filed a total of four such cases.

There are multiples reasons for the increase in prosecutions, one of which is increased efforts by the U.S. Department of Health and Human Services to raise awareness of health care fraud.  In January, HHS outlined and revised its strategies aimed at combating fraud under PPACA, the new health care law.  These new strategies include tougher screenings for providers wishing to participate in Medicare and Medicaid as well as the withholding of payments to certain recipients under investigation.  One month later, in a move to attract additional publicity to health care fraud, HHS’ Inspector General, Daniel Levinson, initiated his agency’s first top 10 “Most Wanted Fugitives” list.

The federal government’s efforts are working.  “The Feds are discovering what the states’ MFCUs [Medicaid fraud control units] have known for years,” says Richard S. Harrow, Of Counsel to O’Connell and Aronowitz and a former prosecutor with 30 years experience in Medicare and Medicaid fraud.   “By adding more firepower in the form of additional investigators and prosecutors, as well as targeting specific cities, the number of Medicare and Medicaid fraud prosecutions will naturally increase and seem limitless.”  Harrow added, however, that he feels the “fix has to be systematic rather than through the criminal justice system.”

If there is to be a “fix,” the success or failure of the federal government’s increase in health care fraud prosecutions will likely play a vital role.

This post was contributed by Aaron Mensh.