Every healthcare provider involved in billing federal healthcare programs knows healthcare reform is a reality. The Patient Protection and Affordable Care Act (PPACA) and the Healthcare and Education Reconciliation Act of 2010 (HCERA) were signed into law by President Obama in March 2010. What providers may not be fully aware of is the number of significant fraud changes included in both statutes that will increase potential fraud exposure for them in the months and years ahead. This article summarizes some of the most significant fraud changes included in these reform statutes.

A. Increased Funding for Fraud and Enforcement Efforts

The Omnibus Appropriations Act of 2009 provided for a one-time, $198 million enhancement in fraud enforcement-related spending. The 2010 federal budget adds another $311 million in funding over a two year period, amounting to a 50% increase over the FY09 funding level. The proposed 2011 budget would add another $250 million for the DOJ/HHS joint enforcement effort known as the Health Care Fraud and Prevention Enforcement Action Team (or “HEAT”).

The HEAT program was announced in May 2009 as a Cabinet-level effort by DOJ, HHS-OIG, and the Centers for Medicare and Medicaid Services (CMS) designed specifically to combat Medicare fraud.