Grassley demands answers on recent Medicare fraud prevention investments

The top Republican on the Senate Finance Committee wants the federal government to explain why the conviction rate for Medicare fraud is largely flat despite the millions recently spent to beef it up.

The Democratic Congress appropriated $198 million in discretionary funds for Medicare fraud prevention last year on top of an $11 million increase in mandatory spending. But the number of criminal convictions fell slightly that year (from 588 to 583), prompting Sen. Charles Grassley (R-Iowa) to demand some answers in a letter he sent to the heads of the Health and Human Services and Justice departments.

The letter also points out that the total number of defendants in 2009 — 803 — only represents an increase of six defendants over 2008 and 17 over 2007. And the number of new criminal cases filed dropped in 2009, from 502 to 481.

"The decline in criminal cases filed, the stagnant number of criminal defendants, and the low level of actual convictions raise serious questions about how DOJ and HHS are allocating resources to combat criminal health care fraud," Grassley wrote.

The letter also raises questions about the total number of criminal cases filed dropped despite the Obama administration's announcement in May 2009 that the interagency task force dubbed HEAT was being expanded to more areas of the country. While HEAT cases increased from 30 to 82 between 2008 and 2009, the decrease in the overall number of cases last year "raises a question of whether the focus of the HEAT initiative is actually redirecting resources away from overall criminal enforcement of health care laws."

However, a time lag between new Medicare fraud prevention investments and any surge in new cases and convictions is to be expected because it takes time to build criminal cases.

A spokesperson for the Justice Department responds that because HEAT was expanded from two cities to seven metropolitan areas last year, the department's Medicare Fraud Strike Force has "charged more than 500 defendants with seeking to defraud Medicare of more than $1 billion in taxpayer dollars."

"Together the Departments of Justice and Health and Human Services have taken unprecedented steps in the last two years to fight fraud, waste and abuse of the Medicare system through our HEAT initiative, and we have seen concrete results," the spokesperson said.