Home Health & Hospice Week

Nine Medicare fraud strike force teams contribute to record-setting fraud recoveries.

Federal authorities have cracked down on Medicare fraud, and they have the results to prove it.

The government's health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in fiscal year 2011, the Department of Health and Human Services and the Department of Justice say in a release. That's the largest sum ever recorded in a single year, the agencies tout.

Recoveries from home care providers appear to have made up a significant portion of that record-setting number, judging from the laundry list of home care convictions, guilty pleas, and settlements reached in Florida, Texas, California, Mich-igan, and Illinois -- plus high-profile settlements with national chains Gentiva Health Services Inc. and Maxim Healthcare Services Inc.

Assisting in those efforts were Medicare fraud strike force teams in nine cities across the country, HHS and the DOJ note in their Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2011. "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 along with chronic fraud by criminals masquerading as health care providers or suppliers," the report explains.

Stats: In FY 2011, strike force operations charged a record number of 323 defendants, who allegedly billed the Medicare program more than $1 billion, HHS and the DOJ note. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. The average prison sentence in strike force cases in FY 2011 was more than 47 months.

"Fighting fraud is one of our top priorities," HHS Secretary Kathleen Sebelius says.

The report also points out the HHS Office of Inspector General's audit and evaluation targets, including hospice services furnishing in nursing homes. "Medicare spending on hospice care for nursing facility residents has grown nearly 70 percent since 2005 and ... hundreds of hospices, most of which were for profit, had more than two-thirds of their beneficiaries in nursing facilities in 2009," the report highlights.

The report is online at http://oig.hhs.gov/publications/docs/hcfac/hcfacreport2011.pdf.