Former IG: Health care fraud still a federal priority
Former Inspector General Richard Kusserow says that hardly a day goes by when his firm, Strategic Management Associates in Alexandria, VA, is not asked if the redirection of federal resources to homeland security means that the U.S. Department of Justice and the Department of Health and Human Services’ (HHS) Office of Inspector General plan to reduce enforcement efforts in health care.
Kusserow says he finds it inconceivable that HHS Inspector General Janet Rehnquist, a career prosecutor, would be soft on fraud and abuse. On top of that, the Health Care Portability and Accountability Act (HIPAA) guarantees that funding for both HHS and the FBI to fight health care fraud will continue to increase 15% a year until 2003, he points out.
"Slowly, since Sept. 11, we have been getting back to business," confirms Timothy Delaney, unit chief of the FBI’s health care fraud unit. Terrorism has sapped many resources, but Delaney says his unit managed to preserve its budget nonetheless.
Some of the FBI’s activities amount to new business, including a relatively new Cyber Crimes Division. "We have not quite figured out if it is a health care provider and they are billing over the Internet, if that is a cyber crime or health care fraud," adds Delaney.
Another area where the FBI wants to expand its reach is data mining, which it is coordinating with the Centers for Medicare & Medicaid Services and HHS, he says.
Delaney says the FBI currently has roughly 3,000 open health care cases. In 1992, that number was only 592, but it has held steady since 1999. The HIPAA money Kusserow points to has increased the number of directly funded agents from 111 in 1992 to 435 today, he says.
According to Delaney, the FBI is working on numerous kickback cases involving laboratories as well as durable medical equipment and blood tests.
In fact, he says, the FBI’s durable medical equipment initiative in California has resulted in $64 million in fraudulent billings, 195 individuals charged with health care fraud, 103 guilty pleas, and $33 million in restitution. "We are trying to copy that and take that nationally," he says.
Delaney says the FBI also is investigating group therapy at mental health clinics as well as kickbacks at nursing homes.
The bureau also plans to expand its investigations into both "black-market" and "gray-market" diversion of prescription drugs. Some of those drugs are sold out the back door and repackaged, while an assortment of schemes involve Medicare-covered drugs, says Delaney.
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