Fighting Health Care Fraud: The Power of One

Nurse in handcuffsCan a single federal prosecutor make much of a difference in the war against health care fraud?

Yes, a new analysis of Justice Department statistics suggests. And the stakes are enormous: Fraud is thought to cost the Medicare program alone up to $90 billion each year.

The analysis – from the Transactional Records Access Clearinghouse (TRAC), a nonprofit group based at Syracuse University – shows that federal prosecutors filed a record number of new health care fraud cases in fiscal 2013: 377, or more than one for every day of the year. The U.S. Attorney’s Office for the Southern District of Illinois, which covers 38 counties and a population of about 1.2 million, led the way, with a prosecution rate that was more than eight times the national average.

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The federal prosecutor there, U.S. Attorney Stephen Wigginton, told the Associated Press that he was “frankly surprised” to learn that his office was in the No. 1 spot. But perhaps he shouldn’t have been. Wigginton told AP that, since his appointment in August 2010, he’s placed a special emphasis on fighting health care fraud. Last year, for example, his office indicted more than 30 individuals for allegedly defrauding a Medicaid program that’s meant to keep people out of nursing homes by paying personal assistants to help them with general household activities and personal care.

“I think we’re very focused and strategic,” Wigginton says.

The lesson hasn’t been lost on Washington. Attorney General Eric Holder, as I wrote back in November, has created a Medicare Strike Force that’s working hard to fight fraud in nine cities nationwide.

“We’re pleased efforts to crack down on Medicare fraud have been returning results,” said Ariel Gonzalez, director of AARP’s federal health and family advocacy. “We continue to encourage individuals to take a detailed look at their explanation of benefits and report things of concern.”

Learn more about how to protect yourself at the Fight Health Care Fraud page on the AARP website.

Photo: JaggedPixels/iStockPhoto

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