This Administration has been serious about combating fraud, waste, and abuse. Through the joint efforts of Attorney General Holder and Secretary Sebelius with the Health Care Fraud Prevention and Enforcement Action Team (“HEAT"), there have been measurable results. The team has recovered in excess of $4 billion every single year since 2011. This is real money.
There was a time when a hearing on Medicare fraud such as this would have focused solely on the dollar amounts recouped at the back end - after the fraud had been perpetrated and any money that could have been recouped would have been long spent.
Then came the Affordable Care Act, which gave regulators additional new powers to prevent fraud rather than just reactively address it: powers such as expanded payment suspension authority and the requirements to effectively police who gets into the Medicare program, ensuring Medicare participation is reserved for scrupulous providers and suppliers.
So now, when we talk about our fraud prevention efforts, we speak a different language than even five years ago. We speak of payment suspensions in greater numbers. We speak of high-risk or moderate risk providers and suppliers. We talk about fingerprinting owners of high-risk providers and suppliers. We speak of the Fraud Prevention System and predictive analytics designed to monitor for potential fraud on a real-time basis.
Notwithstanding all of the efforts that have been made at transforming Medicare and Medicaid into programs that hold participating providers and suppliers accountable, much more work remains.
With alternative delivery system models, what does fraud, waste, or abuse look like? With the expanded waiver authority that essentially granted federal agencies the ability to issue wide open waivers, what new fraud schemes will emerge?
So, our important work in this area is not done. Much work remains. I know that GAO will continue to play an important role in helping us with our oversight responsibilities, and OIG and CMS will use their expanded authorities to root out fraud, waste and abuse to preserve the Medicare and Medicaid program for future generations.
