The Security Scrutinizer with Howard Anderson

Obama's Anti-Fraud Efforts Questioned

Sen. Grassley Asks for Proof of Effectiveness
Obama's Anti-Fraud Efforts Questioned

Sen. Chuck Grassley, R-Iowa, has asked the administration to prove that its spending to fight Medicare fraud is yielding adequate results. He's ranking member of the Senate Finance Committee, which has jurisdiction over Medicare and Medicaid.

In a letter to Attorney General Eric Holder and Kathleen Sebelius, secretary of Health and Human Services, the senator expressed concern about what he portrayed as a stagnating number of criminal prosecutions for healthcare fraud despite increased federal spending to fight fraud. "Despite the record number of defendants, actual criminal convictions for healthcare fraud violations are flat, resulting in a falling conviction rate," Grassley said.

I want to know why the Justice Department is having a tougher time putting people behind bars when we're giving them millions more to do the job. 

"I want to know why the Justice Department is having a tougher time putting people behind bars when we're giving them millions more to do the job."

Grassley asked the administration for detailed statistics on fraud prevention efforts as well as costs.

Administration's Campaign

The Obama administration recently called attention to its Medicare and Medicaid anti-fraud efforts with a series of four regional healthcare fraud prevention summits convened by Holder and Sebelius.

At one of those meetings, they announced plans to invest in predictive modeling applications to help detect fraud in the government healthcare programs.

In October, the administration touted two major fraud cases in an attempt to illustrate the results of their crackdown efforts.

Federal authorities announced an indictment alleging $200 million in Medicare fraud stemming from bogus mental health therapy sessions for the elderly in the Miami area.

And in another case, authorities charged 44 alleged members and associates of an Armenian-American organized crime enterprise in connection with two massive health insurance fraud schemes. In addition to a $100 million scheme to defraud Medicare, members of the crime ring also were charged in connection with a separate scheme to defraud private health insurers in the New York area.

At one of the summits, Sebelius proclaimed: "This has been a remarkable year for cracking down on healthcare fraud."

Obviously, Grassley strongly disagrees. As the new Congress convenes in January, you can expect Republicans to closely scrutinize Medicare and Medicaid anti-fraud efforts. Whether that will result in any budget cuts or policy changes remains to be seen.

About the Author

Howard Anderson

Howard Anderson

News Editor, ISMG

Anderson is news editor of Information Security Media Group and was founding editor of HealthcareInfoSecurity and DataBreachToday. He has more than 40 years of journalism experience, with a focus on healthcare information technology issues. Before launching HealthcareInfoSecurity, he served as founding editor of Health Data Management magazine, where he worked for 17 years, and he served in leadership roles at several other healthcare magazines and newspapers.

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