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January
24,2011
TheHonorableCharlesE.GrassleyUnitedStatesSenateWashington,D.C.20510DearSenatorGrassley:Thankyouforyourletter,datedDecember17,2010,inquiringabouttheeffortsbytheDepartmentofJustice
(DOl)
andDepartmentofHealthandHumanServices(HHS)tocombathealthcarefraud.Asyounoted,Congresshasmadesignificantinvestmentsinhealthcarefraudenforcement,including,mostrecently,discretionaryfundingincreasesforhealthcarefraudenforcementandpreventioninFiscalYears2009and2010.
DOl
andHHSaregratefulforthesefundingincreasesandwecontinuetobelievethatwehaveputthosefundstogooduseinvestigatingandprosecutinghealthcarefraud.Indeed,astheanswersbelowtothequestionsposedinyourletterdemonstrate,farfromtherebeingastagnationinhealthcarefraudprosecutions,FiscalYear2010wasarecordyearinwhich931healthcarefrauddefendantswerecharged,reflectinga16%increaseoverthepriorfiscalyear.
Question1.ProvideadetailedbreakdownofthefollowingstatisticsforFY2010:
a.Numberofcriminalhealthcarefraudinvestigationsopenedby
DOl
1,116Numberofcriminalhealthcarefraudinvestigationsopenedby
HHS/OIG
1105NumberofcriminalhealthcarefraudinvestigationsopenedbyFBI883b.NumberofcriminalhealthcarefraudinvestigationsoriginatedbyFBI
N/A
(Note:BecauseHeFcasesaretypicallydevelopedthroughcooperativeefforts,theFBIdoesnottrackthenumberofcasesoriginatedbytheFBI.AlthoughtheFBIisDOl'sprimaryinvestigativeagencyinvolvedinthefightagainstHCF,itleveragesitsresourcesthroughinvestigativepartnershipswithagenciessuchasthe
HHS/OIG,
theFDA,theDEA,theDefenseCriminalInvestigativeService,theOfficeofPersonnelManagement,theIRS,andvariousstateandlocalagencies.)c.Numberofcriminalhealthcarefraudinvestigationsoriginatedby
N/AHHS/OIG
BecauseHCFcasesaretypicallydevelopedandinvestigatedthroughcooperativeefforts,theOrGandFBIdonottrackthenumberof
 
TheHonorableCharlesE.GrassleyPage2of16
casesoriginatedbyeitheragency.InvestigativepartnershipsarenotonlyleveragedbetweenOIGandtheFBI,butalsowithagenciessuchastheFDA,theDEA,theDefenseCriminalInvestigativeService,theOfficeofPersonnelManagement,theIRS,andvariousStateandlocalagenciesd.NumberofcriminalcasesfiledbyDOJforhealthcarefraud488e.NumberofcriminaldefendantschargedbyDOJforhealthcarefraud931violations
f.
Numberofcriminalconvictionsforhealthcarefraudprosecuted,orplea726bargained,byDOJg.NumberofcriminalcasesattributedtoHEATstrikeforces140h.Numberofpendingcriminalinvestigations(asendofFY2010)1,787(Note:
DOl
doesnotmaintainHEAT-specificstatisticsastopendingcriminalinvestigations)PleasenotethatthenumberofhealthcarefraudinvestigationsopenedinFiscalYear2010(1,116)ishigherthaninthepreviousFiscalYear(1,014),withthenumberof
DOl
investigationsopenedincreasingby10%versusFiscalYear2009(andbynearly17%versusFiscalYear2008);andthenumberofFBIinvestigationsopenedincreasingbyover18%versusFiscalYear2009(andbynearly32%versusFiscalYear2008).Question2:ProvideadetailedbreakdownofthecoststofundeachHEATtaskforce.IncludeallsourcesoffundingforeachindividualHEATteam,bothfrom
DOJ
and
BHS,
specifyingthesourceofthefunding-HCFAC,directappropriation,3%fundat
DOJ...
etc.Answer:Pleaseseetheattachedspreadsheet(Attachment1)fortheresponse.Inaddition,astoFY2010,StrikeForceexpansionsandadditionalpersonnelwerefundedwithFY2010HCFACfunding.Duetothetimingofthediscretionaryappropriation,HHSandDOJdidnotreceivefundsuntilMarchof2010,whichdelayedplannedactivitiesandresultedinHHSand
DOl
notbeingabletoobligatetheentirefundingappropriatedinFY2010.Consistentwiththeappropriatedperiodofavailability(i.e.2years),HHSand
DOl
intendtoappropriatethesefundsinFY2011insupportofeffortstocombathealthcarefraud.Question3:ProvideadetailedbreakdownofallcriminalcasesbroughtbyeachHEATtaskforce,includingthenumberofdefendants,andadetailedbreakdownofallcriminalconvictions.Answer:TheAttorneyGeneralandSecretarySebeliusannouncedtheHEATInitiativeonMay20,2009andtheformationofaninteragencyDOJ-HHSHEATTaskForce,co-chairedbytheDeputyAttorneyGeneralandHRSDeputySecretary,tooverseeimplementationandoperationsoftheInitiative.Asofthatdate,theMedicareFraudStrikeForceoperatedintwocities:MiamiandLosAngeles.Duringthe18monthsfollowingthecommencementoftheREATlnitiative,theMedicareFraudStrikeForcewasexpandedtofiveadditionalcities,bringingthetotaltosevenlocations.OneofthehallmarksoftheMedicareFraudStrikeForcehasbeentobringhealthcarefraudcaseswithoutdelay-agoalthatisbeingachievedasdemonstratedbythedataprovidedbelowregardingcriminalcases,defendantsandconvictions(includingguiltypleasandtrialconvictions)bycityforMedicareFraudStrikeForcecases.ThetimeperiodcoveredisFY
 
TheHonorableCharlesE.
Grassley
Page3
of
16
2007throughFY2010.Inaddition,statisticsareprovidedforperformancefromMay20,2009-thedateofannouncementoftheHEATInitiative-throughFY201O.
TotalHEATStats:
MedicareFraudStrikeForce
(FYs2007-
May
20,2009-
I
(FirstIndlctment/sAnnounced)
FY2007FY2008FY2009FY20102010)
Sept.
30,2010
Miami(CommencedinMay
2007)
CasesFiled
7864135106
383
170
DefendantsCharged
12794161153
535
231
GuiltyPleas
4389
101
124
357
161
GuiltyVerdicts
4710
5
26
8
LosAngeles(CommencedinMay
2008)
CasesFiled
20133
36
11
DefendantsCharged
34318
73
32
GuiltyPleas
21322
37
23
GuiltyVerdicts
1
3
3
7
6
Detroit(CommencedinJune
2009)
CasesFiled
84
12
12
DefendantsCharged
6233
95
95GuiltyPleas
1639
55
55GuiltyVerdicts
8
8
8
Houston(CommencedinJuly
2009)
CasesFiled
75
12
12
DefendantsCharged
3616
52
52
GuiltyPleas
23
23
23
GuiltyVerdicts7
7
7
Brooklyn(CommencedinDecember
2009)
CasesFiled
9
9
9DefendantsCharged
33
33
33
GuiJtyPleas
2
2
2
GuiltyVerdictsTampa(CommencedinJanuary
2010)
CasesFiled6
6
6DefendantsCharged
10
10
10
GuiltyPleas7
7
7
GuiltyVerdictsBatonRouge(Commencedin
July
2010)CasesFiJed7
7
7
DefendantsCharged
3131
31
GuillyPleasGuiltyVerdicts
(Note:Thesestatisticsdonotincludeallcriminathealthcarefraudcasesfiledanddefendantscharged;theyonlyincludethesubset
of
StrikeForceprosecutionstatisticsforeachdistrict.)
ThefollowingtableprovidestotalstatisticsfortheMedicareFraudStrikeForcesitesforthesametimeperiods:
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