U.S. to Bolster Health Care Fraud Attack

The federal government plans to more than double the number of states where it is aggressively combating fraud in Medicare and Medicaid, officials said, warning that some criminals active in the drug trade are targeting the health care system.

Operation Restore Trust, which has been running anti-fraud campaigns in five states, including California, will be expanded this year to Ohio, Connecticut, Iowa, Oklahoma, Tennessee and South Carolina, health care officials revealed Monday at the annual convention of the American Society on Aging here.

The government is alarmed because the FBI has identified known drug traffickers who are moving into health care fraud, said William Benson, deputy assistant secretary at the Federal Administration on Aging. Compared with the drug trade, “it is harder to get caught, the penalties are much less and it sure is safer than on the street,” he said.

Also as part of a focus on health care fraud, the Clinton administration unveiled in Washington on Tuesday a legislative proposal asking for new weapons in the fight.

“We cannot tolerate fraud that robs taxpayers even as it harms those of us to whom we owe a great deal,” President Clinton announced at the White House. Fraud in federal health care programs is “a broad tax that falls on all our taxpayers,” he said.

The proposed legislation would bar convicted felons from participating as providers or suppliers to Medicare or Medicaid. Current law only bars those previously convicted of a felony related to health care.

This provision would help with the growing problems of criminals, crooks and con artists from other fields, such as drug trafficking, who are trying to steal a share of the $200 billion that the government spends annually for Medicare and the $100 billion that it and the 50 states spend for Medicaid.

The proposed bill also would require providers to file their Social Security numbers with their applications. This would enable the government to track fraudulent operators as they move their business operations from one state to another.

Health care fraud once was regarded as a low-priority crime rarely prosecuted by the federal government. But as part of the special attention it is getting from the Justice Department, more than $800 million has been recovered from medical testing laboratories, which billed Medicare for blood tests that were not requested by doctors.

Medicare, which serves those 65 years of age and over and the disabled, and Medicaid, which pays medical and nursing home bills for the indigent, are among the fastest growing programs in the federal budget. Officials see the fight against fraud and abuse as a promising route for saving significant amounts of money to help relieve the financial constraints both programs may face in the future.

The six states added to Operation Restore Trust were chosen in part because they have high concentrations of Medicare beneficiaries, said Judy Holtz, spokeswoman in Washington for the inspector general’s’ office of the Department of Health and Human Services. The program began two years ago in states with large populations. Aside from California, they were Texas, New York, Illinois and Florida.

Scams targeted by the program include billing Medicare for nonexistent treatments to people who have died, marking up the price of adult diapers by as much as 1,000% and billing them as “urinary incontinence control systems,” and buying wheelchairs for nursing homes whether needed or not.