Health Care Fraud Management

The Health Care Fraud Prevention and Enforcement Action Team (HEAT)
And Its Effect on Health Care Compliance and Law Enforcement

Thaedra Frangos
ECM 627-Z1
Fraud Management: Risk and Compliance
Professor Gary Reynolds

Abstract The Health Care Fraud Prevention and Enforcement Action Team (HEAT) was created in 2009 in response to nothing short of an egregious and systemic theft problem bleeding our health care system and the American taxpayers near dry. Peter Orszag, Director of the White House Office of Management and Budget, stated in a media briefing in 2009 that of the $98 billion in improper health care payments, $54 billion could be attributed to Medicare and Medicaid.
Currently, HEAT’s Medicare fraud Strike Force has expanded to include nine cities across the United States, (STOP Medicare Fraud 2013) and, to say the least, ineffective programs are usually not expanded. Therefore, it is clear that the collaborative efforts of local, state, and federal law enforcement agencies, coupled with the prosecutorial strength of government agencies and analytical knowledge and increased proactive compliance efforts of private industry, health care fraud in the United States is beginning to feel the pressure. The recovery of $4.2 billion dollars from health care fraud and the mitigation of nearly $14.9 in fraud speaks for itself. (HEAT 2013) Although the ultimate goal is not to recover the funds from, but rather prevent the theft of funds, HEAT is on the right track. With the inception of the Affordable Care Act, I believe the focus of HEAT and its Medicare Strike Force will be forced to adapt again. In the world of ever-changing white-collar crime, the methodologies of compliance programs and law enforcement must also stay dynamic. But these are trends that HEAT and the Medicare Strike Force will pick up on, and with continued diligence, will be able to mitigate, saving taxpayers millions of dollars while preserving the integrity of our health care
(August 2012). Medicare Fraud Estimates: A Moving Target? The Sentinel. Retrieved from: http://www.smpresource.org/Content/NavigationMenu/AboutSMPs/MedicareFraudEstimatesAMovingTarget/Medicare_Fraud_Estimates.pdf

HEAT: Office of the Inspector General, Health and Human Services. (Spring 2011) HEAT Provider Compliance Training- Take the Initiative: Cultivate a Culture of Compliance with Health Care Laws… Operating an Effective Compliance Program. Retrieved from: http://oig.hhs.gov/compliance/provider-compliance-training/files/OperatinganEffectiveComplianceProgramFinalBR508.pdf

US Department of Health and Human Services: Office of the Inspector General. (August 7, 2012). Focus on Compliance: The Next Generation of Corporate Integrity Agreements. Retrieved from: http://oig.hhs.gov/compliance/corporate-integrity-agreements/resources.asp

STOP Medicare Fraud: US Department of Health and Human Services and the US Department of Justice. (February 13, 2013). New Tools to Fight Fraud, Strengthen Federal and Private Health Programs, and Protect Consumer and Taxpayer Dollars: Recent Initiatives Help the Government Fight Fraud, Strengthen Health Insurance Programs, and Protect Consumer and Taxpayer Dollars. Retrieved from: