Departments

HEAT Task Force: Health Care Fraud Prevention and Enforcement Action Team (HEAT)

Background

In May 2009, the Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder pledged to fight waste, fraud, and abuse in Medicare with the creation of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). With the creation of HEAT, fighting Medicare fraud has become a top priority for both Department of Justice (DOJ) and HHS.

Mission

To assemble and strengthen significant resources across government entities to prevent waste, fraud and abuse in the Medicare and Medicaid programs and crack down on the fraud perpetrators who are abusing the system and stealing billions of dollars.

To reduce skyrocketing health care costs and improve the quality of care by ridding the system of perpetrators who are preying on Medicare and Medicaid beneficiaries and harming the short-term and long-term solvency of these essential programs.

Turning up the HEAT on Fraud

Medicare Fraud Strike Forces, law enforcement agencies and Medicare contractors are using great scrutiny in developing effective strategies and use of technology in detecting health care fraud and improper payments. The HEAT initiative includes stopping fraud before it happens and eliminating fraudulent people in the Medicare program.

The False Claims ActAdobe Portable Document format and its whistleblower provisions are particularly effective in the fight against Medicare fraud. False Claims Act allows for penalties of between $5,000 and $10,000 for each false claim plus damages of up to three times the amount of the erroneous payment. People who "knowingly" submit false claims may be found liable under the act for penalties for each false claim submitted. People who submit claims to Medicare with any deliberate omission, misrepresentation, or falsification of any information contained in the enrollment application or contained in any communication (by any means) to Medicare may be punished by criminal, civil, or administrative penalties and/or imprisonment.

Strike Force teams have obtained indictments of more than 500 individuals who collectively have falsely billed the Medicare program for billions dollars. An indictment is merely an allegation, and defendants are presumed innocent until and unless proven guilty.

Strike Force teams are committed to prosecuting anyone operating or considering operating a health care fraud scheme around the country. Take notice that they will be held accountable.

Providers Responsibility for Knowing Guidelines

According to the Medicare Claims Processing Manual, Chapter 30, Section 40.1Adobe Portable Document format , a Medicare provider is responsible to know the rules and regulations that apply to all services billed by the provider, or billed on behalf of the provider, to the Medicare program. Medicare providers may be held liable for any activity performed under their Medicare provider number. Ignorance of the laws and regulations is no excuse.

Medicare providers are required to sign a certification statement upon enrollment with the Medicare program. By signing the Certification Statement, the provider certifies acknowledgement and agreement to adhere to:

Abide by the Medicare laws, regulations, and program instructions that apply.
Any deliberate omission, misrepresentation, or falsification of any information contained in the application or contained in any communication (i.e., claim submission, verbal communication, electronic communication, written communication) supplying information to Medicare, or any deliberate alteration of any text on the application form, may be punished by criminal, civil, or administrative penalties including, but not limited to, the denial or revocation of Medicare billing privileges, and/or the imposition of fines, civil damages, and/or imprisonment.
Provider will not submit claims with deliberate ignorance or reckless disregard of their truth or falsity (i.e., grossly negligent without concern and/or ignoring any potential consequences of so doing).

Heat Task Force Success(external link)

Expansion of the Medicare Fraud Strike Force has been a significant factor of HEAT. Strike Force Teams initially began in Miami in 2007 and expanded to Los Angeles in 2008. Since the formation of HEAT, the Strike Force has expanded to Detroit, MI; Houston, TX; Brooklyn, NY; Baton Rouge, LA; and Tampa Bay, FL.