The U.S. Department of Justice and the U.S. Department of Health and Human Services ("HHS") continued their series of joint Regional Health Care Fraud Prevention Summits, with the fifth summit held on March 15, 2011, in Detroit and the sixth in Philadelphia on June 17, 2011. As described in a HHS press release, the summits aim to "bring together a wide array of federal, state and local partners … to discuss innovative ways to eliminate fraud within the U.S. health care system."
A key aspect of the departments' overall health care fraud-fighting effort has been the Health Care Fraud Prevention and Enforcement Action Team (known as "HEAT") and the operations of Medicaid Strike Force teams in nine "health care fraud hot spots" across the nation. Since their inception in 2007, the Strike Force teams have brought charges of Medicaid fraud against more than 1,000 defendants, involving more than $2.3 billion in claims. In fiscal year 2010, the Medicare Health Insurance Trust Fund recovered more than $4 billion in fraudulent claims – including $2.5 billion in judgments and settlements under the FCA, a 53 percent increase over fiscal year 2009's $1.6 billion inrecoveries.
The government is now looking to build on that record. During the June summit in Philadelphia, Secretary Sebelius announced that, starting in July, "HHS will begin using innovative predictive modeling technology to identify fraudulent Medicare claims on a nationwide basis, and stop claims before they are paid." HHS explained that this new tool is designed to help move health care fraud enforcement "beyond its former ‘pay and chase' recovery operations to an approach that focuses on preventing fraud and abuse before payment is made." The rollout of this new technology could have profound impacts on the government's health care fraud prevention efforts and future litigation under the FCA