National

$1.7 billion to fight health fraud

WASHINGTON — Congress is set to grant President Obama's request for a record $1.7 billion to fight health-care fraud, in part to almost triple investigations into crime rings that steal from Medicare.

The money, included in House and Senate versions of a fiscal 2011 spending bill for the Health and Human Services Department, amounts to a $250 million increase. Almost half of that, $116 million, would go toward expanding a program of fraud "strike forces" from seven cities to 20.

Health insurers stand to benefit from an increase in the federal government's fraud effort. Insurers are often victimized by the same criminals that target Medicare, said Louis Saccoccio, executive director of the National Health Care Anti-Fraud Association, a Washington-based group.

"If a certain health provider is defrauding Medicare there's a good chance they're defrauding the private side as well," Saccoccio said.

Medicare estimates that about 7.8 percent of the $308 billion it spent in fiscal 2009 was improper, a term that encompasses non-criminal waste along with fraud. There is no similar estimate for the private market, Saccoccio said, though his group estimates that about 3 percent of national health spending is lost to fraud every year. National health spending totaled about $2.3 trillion in 2008, according to the most recent estimate from the government's Centers for Medicare and Medicaid Services.

The strike force program has stopped fraud schemes totaling about $1.9 billion and led to charges against more than 800 people, according to Laura Sweeney, a departmental spokeswoman.

The amount of fraud the strike forces have deterred from happening is "far higher but nearly impossible to calculate," said Kirk Ogrosky, a former federal prosecutor who began the strike force program in Miami in 2007.

In the strike force's first year operating in south Florida, Ogrosky said, Medicare observed a $1.2 billion decrease in claims from the area for purchases of home medical equipment, the industry that prosecutors first targeted.

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