Health Care Enforcement Defense Alert: DOJ and HHS Announce Efforts to Obtain Proactive Data Mining Tools to Supplement Anti-Fraud Efforts


In yet another health-related joint law enforcement initiative, Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced yesterday, December 16th, that they would be seeking to acquire a sophisticated predictive modeling data analysis system. This announcement continues the Obama Administration’s commitment to combating health care fraud and abuse, an effort that Congress has supported with increased funding. As part of Health Care Reform, in response to its funding request, the Administration received from Congress an additional $350 million to supplement fraud-fighting efforts. Increased technological support for federal health care fraud enforcement efforts, both for detection and prevention, was a priority in the Administration’s funding request.

The United States Departments of Justice (DOJ) and HHS previously announced that part of the enhanced funding would be used to expand their Health Care Fraud Prevention and Enforcement Teams (HEAT). Operating in South Florida and Los Angeles, HEAT strike forces include attorneys and investigators from multiple federal agencies collaborating on investigations and prosecutions of fraudulent Medicare billing. HHS/DOJ report that, since March 2007, HEAT operations have resulted in the indictments of more than 850 individuals alleged to have falsely billed Medicare for more than $2.1 billion. With the new funding, HHS and DOJ are expanding HEAT strike forces to five new locations: Houston, Texas; Detroit, Michigan; Brooklyn, New York; Baton Rouge, Louisiana; and, Tampa, Florida.

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