PHILADELPHIA — The federal government is gaining ground in the battle against people who commit health care fraud, recovering nearly $8 billion dollars over the past two years, Attorney General Eric Holder told a health care forum Friday.
Holder and Health and Human Services Secretary Kathleen Sebelius addressed a summit on health care fraud at the University of the Sciences as part of a series the government is holding nationwide.
“The vast majority of those who work in the health care industry are honest people who want to help patients and follow the law,” Holder said. “But we also know that a few bad apples have created an industry-wide problem that simply cannot be ignored.”
Starting July 1, the government will use new technology to identify fraudulent Medicare claims before they are paid by using special algorithms to identify aberrant billing patterns, Sebelius announced.
“We can’t prosecute our way out of this problem,” Sebelius said, adding that the government must make it harder for people to commit fraud in the first place. “We can’t afford to sit around and wait for tips to come in.”
Over the past two years, Holder said, the Justice Department has recovered nearly $8 billion in judgments, settlements, fines, restitutions and forfeitures. About a quarter of that has been collected in the Philadelphia area.
Last year, the government opened more than 900 civil investigations and got more than 700 criminal convictions against people involved in health care fraud schemes, Holder said.
He cited an eastern Pennsylvania case in which prosecutors won a conviction and three-year sentence against a chiropractor who tried to bill nearly $2 million to a private insurer for treatments he never performed.
The government has also charged an ophthalmologist accused of falsifying more than $3 million in fraudulent charges to health care benefit programs, Holder said, and is investigating a private ambulance company that allegedly billed Medicare for the unnecessary transportation of health patients.
“We are striking a blow against deceptive practices across the country,” Holder said.