Chairmen Stark and Lewis , Ranking Members Herger and Boustany, and distinguishedMembers of the Subcommittee, I appreciate the opportunity to appear before you to discuss theefforts of the Department of Justice to enforce laws against health care fraud, along with ourpartners in the Department of Health and Human Services and other federal and state lawenforcement agencies. We are grateful for the Subcommittee’s leadership on this importanttopic, and to the Chairman for inviting me to discuss the Department of Justice’s enforcementefforts to combat fraud in the health care system.Every year, hundreds of billions of dollars are spent to provide health security forAmerican seniors, children, and to the poor and disabled. We have a duty to ensure that taxpayerfunds are well spent and that our citizens who receive treatment paid for by Medicare and othergovernment programs are receiving proper medical care.While most medical providers andhealth care companies are doing the right thing, unfortunately billions of dollars that could bespent on patient care are lost each year to fraud schemes. This is unacceptable.Medicare fraudalso can corrupt the medical decisions health care providers make with respect to their patientsand thereby put patients at risk of harm. For these reasons, the Department of Justice, through itsCriminal, Civil, and Civil Rights divisions, along with the United States Attorneys’ Offices andthe FBI, has redoubled its efforts to protect the public from health care fraud and to help ensurethe integrity of patient care.
FIGHTING MEDICARE FRAUD IS A PRIORITYOF THE DEPARTMENT OF JUSTICE
Health care fraud represents billions of dollars in losses each year to taxpayers andprivate industry, drives up the cost of health care, and requires an urgent response from everylevel of government and the private sector.
The Department of Justice, in coordination with theDepartment of Health and Human Services, and other federal and state law enforcementagencies, recognizes the need to recover those funds and to ensure that such fraud does notreoccur.In 1997, Congress established the Health Care Fraud and Abuse Control (HCFAC)Program under the joint direction of the Attorney General and the Department of Health andHuman Services, acting through HHS’s Inspector General, to coordinate federal, state and locallaw enforcement activities with respect to health care fraud and abuse. Since the inception of theprogram through fiscal year 2009, our Departments have returned more than $16.3 billion to thefederal government, of which $15.6 billion went back to the Medicare Trust Fund. With $15.6billion returned to the Medicare Trust Fund, the average return on investment to the Trust Fundfor funding provided to law enforcement agencies by the 1996 law that created the program,HIPAA, is approximately $4 per dollar spent. These efforts have resulted in more than 5,600criminal convictions for health care fraud offenses.
Because coordination across agencies is an integral part of preventing and prosecutinghealth care fraud, Attorney General Holder and Secretary Sebelius together pledged to strengthenour fight against waste, fraud and abuse in Medicare. To improve that coordination, in May1